What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation and active cancer (n=224). Intervention: Direct oral anticoagulants (DOACs) vs. Warfarin. Primary outcome: Stroke or systemic embolism (p=0.35).

February 24, 2019Open Access

Oral Anticoagulants in Japanese Patients with Atrial Fibrillation and Active Cancer

Key Result

In Japanese patients with atrial fibrillation and active cancer, the rates of stroke or systemic embolism did not differ significantly between those receiving DOACs (2.8%/year) and warfarin (5.4%/year).

Study Design

Type

Cohort (n=224)

Multicenter

Structured PICO

Do DOACs compared to warfarin reduce stroke, systemic embolism, and major bleeding in Japanese patients with atrial fibrillation and active cancer?

Population

224 Japanese patients (mean age 72.7 years, 12.5% female) with atrial fibrillation and active cancer treated with oral anticoagulants, followed for up to 1 year.

Exposure

Direct oral anticoagulants (DOACs: apixaban, rivaroxaban, dabigatran, or edoxaban) for up to 1 year

Comparator

Warfarin for up to 1 year

Outcome

Stroke or systemic embolism and major bleeding (ISTH criteria) at 1 yearhard clinical

In Japanese patients with atrial fibrillation and active cancer, DOACs and warfarin showed comparable, non-negligible rates of thromboembolic and major bleeding events, though the study was limited by a small sample size.

Main Result

Absolute Event Rate: 2.8% vs 5.4%

p-value: p=0.35

Limitations

Single-center retrospective cohort design introduces unavoidable selection bias.
Patients with paroxysmal AF may have been missed since AF was identified solely by electrocardiography.
Small sample size may have limited the analytical power to detect significant differences.
Dosage of oral anticoagulants and coagulation data (e.g., PT-INR) were not collected.

Abstract

Objective Oral anticoagulants (OACs), which include direct oral anticoagulants (DOACs) and warfarin, are widely used for the prevention of thromboembolic events in patients with atrial fibrillation (AF). Cancer is associated with a prothrombotic state as well as an increased bleeding risk. Few data are available on the efficacy and safety of OACs in Japanese cancer patients with AF. We sought to investigate the efficacy and safety of OACs in this population. Methods This retrospective cohort study included active cancer patients in whom AF was recorded by electrocardiography in our hospital from January 2014 to December 2016 and who were treated with DOACs or warfarin. Patients were followed for 1 year. The study outcomes were stroke or systemic embolism and major bleeding. Result A total of 224 patients with AF and active cancer were treated with OACs (DOACs, n=127; warfarin, n=97). Overall, stroke or systemic embolism and major bleeding occurred in seven (3.8%/year) and eight (4.9%/year) patients, respectively. Stroke or systemic embolism occurred in three patients in the DOAC group (2.8%/year) and four patients in the warfarin group (5.4%/year). Major bleeding occurred in four patients in the DOAC group (4.0%/year) and four patients in the warfarin group (6.5%/year). Conclusion The rates of stroke or systemic embolism and major bleeding events were not negligible among Japanese cancer patients with AF receiving OACs. Further investigations on the optimal management of Japanese patients with AF and cancer are needed.

Bookmark

View Full Paper