NOAC vs warfarin: which is better in cancer patients with Afib?

  • Wu VC & al.
  • J Cancer
  • 1 Jan 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • 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.


  • Study did not evaluate the quality of warfarin control by calculating the time in therapeutic range.