April 30, 2023CancersOpen Access

Systematic Review and Meta-Analysis of Oral Anticoagulant Therapy in Atrial Fibrillation Cancer Patients

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Why the study?

Cancer and AF co-occur with heightened thrombotic and bleeding risks, but optimal antithrombotic regimens remain understudied in cancer patients compared to the general population.

Do direct oral anticoagulants reduce ischemic and hemorrhagic events compared to vitamin K antagonists in cancer patients with atrial fibrillation?

Structured PICO

Do direct oral anticoagulants reduce ischemic and hemorrhagic events compared to vitamin K antagonists in cancer patients with atrial fibrillation?

Population

266,865 oncologic patients with atrial fibrillation (AF) pooled from 11 studies

Intervention

Direct oral anticoagulants (DOACs)

Comparator

Vitamin K antagonists (VKAs) / Warfarin

Outcome

Ischemic-hemorrhagic risk profile (ischemic, hemorrhagic, and venous thromboembolic events)hard clinical

In cancer patients with atrial fibrillation, DOACs provide a better safety and efficacy profile compared to VKAs, reducing both stroke and bleeding risks.

Implication

Favors DOACs over VKAs for AF in cancer; extends general-population evidence while flagging higher bleeding risk.

Abstract

(1) Introduction: Cancer and atrial fibrillation (AF) are increasingly coexisting medical challenges. These two conditions share an increased thrombotic and bleeding risk. Although optimal regimens of the most suitable anti-thrombotic therapy are now affirmed in the general population, cancer patients are still particularly understudied on the matter; (2) Aims And Methodology: This metanalysis (11 studies (incl. 266,865 patients)) aims at evaluating the ischemic-hemorrhagic risk profile of oncologic patients with AF treated with oral anticoagulants (vitamin K antagonists vs. direct oral anticoagulants); (3) Results: In the oncological population, DOACs confer a benefit in terms of the reduction in ischemic, hemorrhagic and venous thromboembolic events. However, ischemic prevention has a non-insignificant bleeding risk, lower than Warfarin but significant and higher than the non-oncological patients; (4) Conclusions: Anticoagulation with DOACs provides a higher safety profile with respect to VKAs in terms of stroke reduction and a relative bleeding reduction risk. Further studies are needed to better assess the optimal anticoagulation strategy in cancer patients with AF.