Key result
DOACs linked to ~31% fewer major events vs LMWH in active cancer and AF.
Why the study?
AF is frequently encountered in patients with cancer and poses challenges for anticoagulant management.
Do direct oral anticoagulants improve clinical outcomes compared to low-molecular-weight heparins in patients with active cancer and nonvalvular atrial fibrillation?
Cohort (n=222)
No
Do direct oral anticoagulants improve clinical outcomes compared to low-molecular-weight heparins in patients with active cancer and nonvalvular atrial fibrillation?
Absolute Event Rate: 12.1% vs 17.5%
p-value: p=.036
In patients with active cancer and nonvalvular atrial fibrillation, DOACs were associated with lower rates of the primary composite endpoint, major bleeding, and all-cause mortality compared to LMWH.
DOACs associated with fewer events than LMWH in cancer AF; extends observational data but leaves open randomized confirmation.
BACKGROUND: Atrial fibrillation (AF) is frequently encountered in patients with cancer and poses challenges for anticoagulant management. The present study was conducted to compare clinical outcomes associated with direct oral anticoagulants (DOACs) and low-molecular-weight heparin (LMWH) in individuals with active malignancy and nonvalvular AF (NVAF). METHODS: Data from patients with active cancer who received LMWH or DOACs for NVAF were retrospectively screened. Efficacy, safety, and survival outcomes were analyzed. RESULTS: The study enrolled 222 patients, of whom 25.7% received LMWH and 74.3% received DOACs. Cancer stage, type, and treatment were comparable between groups. The DOAC group had higher CHA2DS2-VA (3.13 ± 1.21 vs. 2.42 ± 1.33; P < .001) and HAS-BLED scores (2.13 ± 0.83 vs. 1.84 ± 0.79; P = .022). The primary composite endpoint occurred more frequently in the LMWH group (17.5% vs. 12.1%; log-rank P = .036). Myocardial infarction was significantly higher in the LMWH group (8.8% vs. 1.8%; log-rank P = .003), while rates of ischemic stroke (3.5% vs. 6.7%; log-rank P = .927) and venous thromboembolism (5.3% vs. 4.8%; P = .537) were similar. Any bleeding (17.5% vs. 13.3%; log-rank P = .039) and major bleeding (7.0% vs. 1.8%; log-rank P = .010) were more frequent with LMWH, whereas clinically relevant non-major bleeding was comparable (10.5% vs. 11.5%; log-rank P = .359). All-cause mortality was significantly higher in the LMWH group (75.4% vs. 49.1%; log-rank P < .001), and LMWH use independently predicted mortality (hazard ratio = 2.14, P < .001, 95%CI: 1.45-3.17). CONCLUSION: Although unmeasured confounders such as drug adherence and selection bias cannot be excluded due to the retrospective design, DOACs appear to be more effective and safer than LMWH in cancer patients with AF.
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Ceren et al. (2026) conducted a cohort in Active malignancy and nonvalvular atrial fibrillation (n=222). Direct oral anticoagulants (DOACs) vs. Low-molecular-weight heparin (LMWH) was evaluated on Primary composite endpoint (p=.036). Direct oral anticoagulants were associated with a lower rate of the primary composite endpoint compared to LMWH (12.1% vs. 17.5%; P=0.036) in patients with active cancer and atrial fibrillation.
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