Key result
In cancer patients with atrial fibrillation, NOACs significantly reduced the risk of ischemic stroke or systemic embolism by 58% (HR 0.42) and major bleeding by 74% (HR 0.26) at 1 year compared to warfarin.
Why the study?
Cancer patients with AF were excluded from major clinical trials, leaving the efficacy and safety of NOACs versus warfarin unclear in this population.
Does novel oral anticoagulant (NOAC) reduce ischemic stroke, systemic embolism, and bleeding compared to warfarin in cancer patients with atrial fibrillation?
Cohort (n=672)
Does novel oral anticoagulant (NOAC) reduce ischemic stroke, systemic embolism, and bleeding compared to warfarin in cancer patients with atrial fibrillation?
Hazard Ratio: 0.42 (95% CI 0.24–0.74)
In cancer patients with atrial fibrillation, NOACs are associated with significantly lower risks of ischemic stroke, systemic embolism, and major bleeding compared to warfarin.
NOACs appear preferable to warfarin in cancer patients with AF; extends major trial data to this previously excluded population.
Background: Cancer patients with atrial fibrillation (AF) were excluded in the major clinical trials. We therefore investigated the efficacy and safety of novel oral anticoagulant (NOAC) versus warfarin in these patients. Methods: Data were retrieved from Taiwan National Health Insurance Research Database during 2010-2017 for patients with AF, excluding those without cancer or >1 cancer, not using anticoagulant, switching of agents, patients age <18, and cancer and AF diagnosed >1 month apart. Primary outcomes are ischemic stroke (IS)/systemic embolism (SE), GI bleeding, major bleeding, intracranial hemorrhage (ICH), acute myocardial infarction (AMI), and death from any cause at 6 months and 1 year. Results: After exclusion criteria and propensity score matching, there were 336 patients in each group. Patients on NOAC had significantly reduced IS/SE (HR=0.45, 95% CI=0.25-0.82), major bleeding (HR=0.21, 95% CI=0.05-0.96), and no ICH at 6 months. In addition, IS/SE (HR=0.42, 95% CI=0.24-0.74), major bleeding (HR=0.26, 95% CI=0.09-0.76), and no ICH at 1 year compared to patients on warfarin. There was no difference on GI bleeding, AMI, and death from any cause at 6 months and at 1 year.
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Wu et al. (2019) conducted a cohort in Atrial Fibrillation and Cancer (n=672). Novel Oral Anticoagulant (NOAC) vs. Warfarin was evaluated on Ischemic stroke (IS)/systemic embolism (SE) at 1 year (HR 0.42, 95% CI 0.24-0.74). In cancer patients with atrial fibrillation, NOACs significantly reduced the risk of ischemic stroke or systemic embolism by 58% (HR 0.42) and major bleeding by 74% (HR 0.26) at 1 year compared to warfarin.
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