*Review* **Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review**

**Grigorios Tsigkas 1,\*, Angeliki Vakka 1, Anastasios Apostolos 1,2, Eleni Bousoula 3, Nikolaos Vythoulkas-Biotis 1, Eleni-Evangelia Koufou 1, Georgios Vasilagkos 1, Ioannis Tsiafoutis 4, Michalis Hamilos 5, Adel Aminian <sup>6</sup> and Periklis Davlouros <sup>1</sup>**


**Abstract:** Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population.

**Keywords:** cancer; acute coronary syndrome (ACS); percutaneous coronary intervention (PCI); dual antiplatelet therapy (DAPT); triple antithrombotic therapy (TAT); atrial fibrillation (AF); cardiotoxicity
