Clinical Outcomes in Atrial Fibrillation Patients With a History of Cancer Treated With Non-Vitamin K Antagonist Oral Anticoagulants: A Nationwide Cohort Study

Data on clinical outcomes for nonvitamin K antagonist oral anticoagulant (NOACs) and warfarin in patients with atrial fibrillation and cancer are limited, and patients with active cancer were excluded from randomized trials. We investigated the effectiveness and safety for NOACs versus warfarin amon...

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Bibliographic Details
Published in:Stroke (1970) 2021-10, Vol.52 (10), p.3132-3141
Main Authors: Chan, Yi-Hsin, Chao, Tze-Fan, Lee, Hsin-Fu, Chen, Shao-Wei, Li, Pei-Ru, Liu, Jia-Rou, Wu, Lung-Sheng, Chang, Shang-Hung, Yeh, Yung-Hsin, Kuo, Chi-Tai, See, Lai-Chu, Lip, Gregory Y.H.
Format: Article
Language:English
Subjects:
Administration, Oral
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Cardiovascular Diseases - prevention & control
Cohort Studies
Female
Hemorrhage - epidemiology
Humans
Male
Middle Aged
Neoplasms - complications
Propensity Score
Retrospective Studies
Stroke - prevention & control
Taiwan
Treatment Outcome
Venous Thrombosis - prevention & control
Vitamin K - antagonists & inhibitors
Warfarin - therapeutic use
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Summary:Data on clinical outcomes for nonvitamin K antagonist oral anticoagulant (NOACs) and warfarin in patients with atrial fibrillation and cancer are limited, and patients with active cancer were excluded from randomized trials. We investigated the effectiveness and safety for NOACs versus warfarin among patients with atrial fibrillation with cancer. In this nationwide retrospective cohort study from Taiwan National Health Insurance Research Database, we identified a total of 6274 and 1681 consecutive patients with atrial fibrillation with cancer taking NOACs and warfarin from June 1, 2012, to December 31, 2017, respectively. Propensity score stabilized weighting was used to balance covariates across study groups. There were 1031, 1758, 411, and 3074 patients treated with apixaban, dabigatran, edoxaban, and rivaroxaban, respectively. After propensity score stabilized weighting, NOAC was associated with a lower risk of major adverse cardiovascular events (hazard ratio, 0.63 [95% CI, 0.50–0.80]; P=0.0001), major adverse limb events (hazard ratio, 0.41 [95% CI, 0.24–0.70]; P=0.0010), venous thrombosis (hazard ratio, 0.37 [95% CI, 0.23–0.61]; P0.05). When compared with warfarin, NOAC was associated with lower risk of major adverse cardiovascular event, and venous thrombosis in patients aged
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.120.033470