Key result
Vitamin K antagonist use was associated with a higher incidence of any cancer compared to DOACs in patients with nonvalvular atrial fibrillation (HR 1.16; 95% CI 1.02-1.32).
Why the study?
The association between the use of vitamin K antagonists and cancer risk reduction remained unclear.
Does the use of vitamin K antagonists compared to direct oral anticoagulants reduce the incidence of cancer in patients with nonvalvular atrial fibrillation?
Cohort (n=39,989)
Does the use of vitamin K antagonists compared to direct oral anticoagulants reduce the incidence of cancer in patients with nonvalvular atrial fibrillation?
In a large real-world cohort of patients with nonvalvular atrial fibrillation, the use of vitamin K antagonists did not demonstrate a chemoprotective effect against cancer when compared with direct oral anticoagulants.
Answers are grounded in this paper and cite their sources.
Association of VKAs or DOACs with cancer incidence in AF remains uncertain from observational data; leaves open need for randomized confirmation.
The association between the use of vitamin K antagonists (VKAs) and cancer risk reduction remains unclear. We aimed to assess the association between the use of VKAs or direct oral anticoagulants (DOACs) and the incidence of cancer in a large cohort of patients with atrial fibrillation (AF) by means of a population-based, propensity-weighted cohort study using population-wide databases including patients diagnosed with nonvalvular AF (NVAF) followed for up of 5 years (median 2.94 years). We created two cohorts based on the initiation therapy (VKA or DOAC). Initiation with VKA or DOAC was defined as filling a prescription with no previous exposure in the preceding 12 months. Cancer diagnoses of any type and for specific tumors (lung, colon, prostate, bladder, and breast). We included 39,989 patients, 31,200 (78.0%) in the VKA cohort. Incidence rate for any cancer was 12.45 per 1,000 person-year in the DOAC cohort vs. 14.55 in the VKA cohort (adjusted hazard ratio (HR): 1.16, 95% confidence interval (CI): 1.02-1.32). In secondary outcomes, no differences were found for specific types of cancer, such as lung (HR: 1.28, CI: 0.89-1.83), colon (HR: 0.84, CI: 0.62-1.13), prostate (HR: 1.40, CI: 0.94-2.10), bladder (HR: 1.07, CI: 0.76-1.52), and breast (HR: 1.05, CI: 0.66-1.69). Sensitivity analyses yielded similar results. Subgroup analyses also produced consistent findings, except for men, for whom VKA was associated with a lower risk of colon cancer (HR: 0.68, 95% CI: 0.48-0.96). Our results do not confirm a chemoprotective effect of VKA when compared with DOAC in a large, real-world cohort of patients with NVAF followed for up to 5 years.
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Iftimi et al. (2021) conducted a cohort in nonvalvular atrial fibrillation (n=39,989). Vitamin K antagonists (VKAs) vs. Direct oral anticoagulants (DOACs) was evaluated on Incidence of any cancer (HR 1.16, 95% CI 1.02-1.32). Vitamin K antagonist use was associated with a higher incidence of any cancer compared to DOACs in patients with nonvalvular atrial fibrillation (HR 1.16; 95% CI 1.02-1.32).
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