Why the study?
Data on outcomes for patients with AF and active cancer are scarce, particularly regarding thrombosis and bleeding risks in elderly patients with non-valvular AF.
Does active cancer affect the risk of stroke/systemic embolic events, major bleeding, and death in elderly patients with non-valvular atrial fibrillation?
Does active cancer affect the risk of stroke/systemic embolic events, major bleeding, and death in elderly patients with non-valvular atrial fibrillation?
In elderly patients with non-valvular atrial fibrillation, active cancer does not increase stroke risk but is associated with higher rates of major bleeding and all-cause mortality.
Active cancer may warrant closer bleeding surveillance in elderly NVAF; extends ANAFIE data but leaves anticoagulation guidance open.
BACKGROUND: Data on outcomes for patients with atrial fibrillation (AF) and active cancer are scarce. The effect of active cancer on thrombosis and bleeding risks in elderly (≥75 years) patients with non-valvular AF (NVAF) enrolled in the All Nippon AF In the Elderly (ANAFIE) Registry were prospectively analyzed. METHODS AND RESULTS: In this subanalysis of the ANAFIE Registry, a prospective, multicenter, observational study conducted in Japan, we compared the incidence rates of clinical outcomes between active cancer and non-cancer groups. Relationships between primary outcomes and anticoagulation status were evaluated. Of the 32,725 patients enrolled in the Registry, 3,569 had active cancer at baseline; 92.0% of active cancer patients received anticoagulants (23.7%, warfarin; 68.2%, direct oral anticoagulants [DOACs]). Two-year probabilities of stroke/systemic embolic events (SEE) were similar in the cancer (3.33%) and non-cancer (3.16%) groups. Patients with cancer had greater incidences of major bleeding (2.86% vs. 2.04%), all-cause death (10.95% vs. 6.77%), and net clinical outcomes (14.63% vs. 10.00%) than those without cancer. In patients without cancer, DOACs were associated with a decreased risk of stroke/SEE, major bleeding, all-cause death, and net clinical outcome compared with warfarin. No between-treatment differences were observed in patients with active cancer. CONCLUSIONS: Active cancer had no effect on stroke/SEE incidence in elderly NVAF patients, but those with cancer had higher incidences of major bleeding events and all-cause death than those without cancer.
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Ikeda et al. (2021) studied this question.
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