In patients with non-valvular atrial fibrillation treated with DOACs, newly diagnosed cancer during follow-up significantly increased the risk of overall bleeding (HR 2.67) compared to those without new cancer.
Cohort (n=1,170)
No
Does newly diagnosed cancer increase the risk of bleeding events in patients with non-valvular atrial fibrillation treated with DOACs?
In patients with non-valvular atrial fibrillation taking DOACs, newly diagnosed cancer during follow-up is a strong independent predictor of major bleeding, whereas cancer present at baseline is not.
Estimación del efecto: HR 2.67 (95% CI 1.8-3.89)
Tasa de eventos absoluta: 47.6% vs 19.2%
valor p: p=<0.001
BACKGROUND: In patients with atrial fibrillation (AF), the association between cancer and cardioembolic or bleeding risk during oral anticoagulant therapy still remains unclear. PURPOSE: We aimed to assess the impact of cancer present at baseline (CB) or diagnosed during follow-up (CFU) on bleeding events in patients treated with direct oral anticoagulants (DOACs) for non-valvular AF (NVAF) compared with patients without CB or CFU, respectively. METHODS: All consecutive patients with NVAF treated with DOACs for stroke prevention were enrolled between January 2017 and March 2019. Primary outcomes were bleeding events or cardiovascular death, non-fatal stroke and non-fatal myocardial infarction, and the composite endpoint between patients with and without CB and between patients with and without CB. RESULTS: The study population comprised 1170 patients who were followed for a mean time of 21.6 ± 9.5 months. Overall, 81 patients (6.9%) were affected by CB, while 81 (6.9%) were diagnosed with CFU. Patients with CFU were associated with a higher risk of bleeding events and major bleeding compared with patients without CFU. Such an association was not observed between the CB and no CB populations. In multivariate analysis adjusted for anemia, age, creatinine, CB and CFU, CFU but not CB remained an independent predictor of overall and major bleeding (hazard ratio HR 2.67, 95% confidence interval CI 1.8-3.89, p < 0.001; HR 3.02, 95% CI 1.6-3.81, p = 0.001, respectively). CONCLUSION: During follow-up, newly diagnosed primitive or metastatic cancer in patients with NVAF taking DOACs is a strong predictor of major bleeding regardless of baseline hemorrhagic risk assessment. In contrast, such an association is not observed with malignancy at baseline. Appropriate diagnosis and treatment could therefore reduce the risk of cancer-related bleeding.
Angeli et al. (Fri,) conducted a cohort in Non-valvular atrial fibrillation (n=1,170). Newly diagnosed cancer during follow-up (CFU) vs. No cancer diagnosed during follow-up was evaluated on Overall bleeding events (HR 2.67, 95% CI 1.8-3.89, p=<0.001). In patients with non-valvular atrial fibrillation treated with DOACs, newly diagnosed cancer during follow-up significantly increased the risk of overall bleeding (HR 2.67) compared to those without new cancer.