Key result
In patients with non-valvular atrial fibrillation and newly diagnosed cancer, NOACs significantly reduced the incidence of ischemic stroke or systemic embolism (1.3% vs 5.9%/year) compared to warfarin.
Why the study?
Do NOACs reduce ischemic stroke/systemic embolism, major bleeding, and all-cause death in non-valvular atrial fibrillation patients with newly diagnosed cancer compared to warfarin?
Cohort (n=776)
No
Do NOACs reduce ischemic stroke/systemic embolism, major bleeding, and all-cause death in non-valvular atrial fibrillation patients with newly diagnosed cancer compared to warfarin?
Absolute Event Rate: 1.3% vs 5.9%
p-value: p=<0.001
NOACs appear safer and more effective than warfarin in patients with non-valvular atrial fibrillation and newly diagnosed cancer, particularly within the first year of cancer diagnosis.
Supports NOAC preference over warfarin in new cancer with AF; hypothesis-generating and requires RCT confirmation.
BACKGROUND AND OBJECTIVES: There are limited data on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer. We aimed to assess the efficacy and safety of NOACs in AF patients with cancer in this study. METHODS: In 2,568 consecutive non-valvular AF patients with newly diagnosed cancer, we analyzed ischemic stroke/systemic embolism (SE), major bleeding, and all-cause death. Based on propensity score matching, 388 matched pairs were included in the NOAC and warfarin groups. RESULTS: Patient baseline characteristics were comparable between the matched groups. During median follow-up of 1.8 years, the NOAC group had significantly lower incidences of ischemic stroke/SE (p<0.001), major bleeding (p<0.001), and all-cause death (p<0.001) than the warfarin group. Moreover, the incidence of major bleeding was significantly lower in the NOAC group than in the warfarin group with optimal international normalized ratio control (p=0.03). Especially, within 1 year after cancer diagnosis, the incidences of all clinical events were significantly lower in the NOAC group than in the warfarin group. CONCLUSIONS: In AF patients with newly diagnosed cancer, NOACs showed lower incidences of ischemic stroke/SE, major bleeding, and all-cause death than warfarin, especially within 1 year after cancer diagnosis.
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Lee et al. (2018) conducted a cohort in Non-valvular atrial fibrillation with newly diagnosed cancer (n=776). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Warfarin was evaluated on Ischemic stroke/systemic embolism (SE) (p=<0.001). In patients with non-valvular atrial fibrillation and newly diagnosed cancer, NOACs significantly reduced the incidence of ischemic stroke or systemic embolism (1.3% vs 5.9%/year) compared to warfarin.
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