Takeaway
- In patients with cancer and atrial fibrillation (Afib), novel oral anticoagulant (NOAC) use was associated with a significant reduction in ischaemic stroke/systemic embolism, major bleeding and intracranial haemorrhage compared with warfarin.
Why this matters
- Currently, there is no guideline for the clinical management of patients with cancer and Afib who are less likely to receive adequate treatment for the concomitant diseases.
- Findings suggest NOACs may be preferred over warfarin in cancer patients with Afib.
Study design
- Population-based cohort study included 672 patients with cancer and Afib who received NOACs (n=336) and warfarin (n=336) after propensity score matching.
- Primary outcomes: ischaemic stroke (IS)/systemic embolism (SE), gastrointestinal (GI) bleeding, major bleeding, intracranial haemorrhage (ICH), acute myocardial infarction (AMI) and death from any cause at 6 months and 1 year.
- Funding: National Taipei University and Chang Gung Medical foundation.
Key results
- At 6 months, NOACs vs warfarin group had significantly reduced risk for:
- IS/SE (HR, 0.452; 95% CI, 0.25-0.817) and
- major bleeding (HR, 0.209; 95% CI, 0.046-0.956).
- At 1 year, NOACs were associated with a reduction in the risk for IS/SE (HR, 0.42; 95% CI, 0.239-0.739) and major bleeding (HR, 0.257; 95% CI, 0.086-0.764) compared with warfarin.
- No significant difference was observed in the risk for ICH at 1 year between both the groups.
- At 6 months and at 1 year, NOACs vs warfarin group did not differ in the risk for:
- GI bleeding (HR, 0.262 [95% CI, 0.056-1.233] and 0.365 [95% CI, 0.118-1.131]);
- AMI (HR, 1.596 [95% CI, 0.266-9.555] and 1.923 [95% CI, 0.459-8.066]); and
- death from any cause (HR, 1.198 [95% CI, 0.86-1.67] and 0.969 [95% CI, 0.739-1.27]), respectively.
Limitations
- Study did not evaluate the quality of warfarin control by calculating the time in therapeutic range.
References
References
