Outcomes by Class of Anticoagulant Use for Nonvalvular Atrial Fibrillation in Patients With Active Cancer

Figures

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  Figure 1. Study Flow Diagram Criteria used for the selection of patients. The inclusion and exclusion criteria of this study yielded 1,293 patients with active cancer and nonvalvular atrial fibrillation taking oral anticoagulant agents. Patients taking more than 1 anticoagulant agent, those who had changes in anticoagulant agents, those with diagnoses of valvular atrial fibrillation, and duplicate patients were removed. The remaining 1,133 patient were 1:1 propensity matched into direct oral anticoagulant agent (DOAC) and warfarin cohorts.

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  Figure 2. Kaplan-Meier Plot for Overall Survival Comparison of overall survival in the propensity-matched cohort of patients receiving direct oral anticoagulant agents (DOACs) vs warfarin. Time-to-event comparison using a Kaplan-Meier plot was used, and survival curves were compared using a log-rank test. No significant difference was observed in overall survival between patients receiving DOACs and those receiving warfarin (P = 0.23). This analysis demonstrated that anticoagulant agent type was not significantly associated with overall survival.

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  Figure 3. Cumulative Incidence Plots for Outcomes by Anticoagulant Agent Comparison of cumulative incidence of cerebrovascular accident (CVA) (A), intracranial hemorrhage (ICH) (B), gastrointestinal bleeding (GIB) (C), and any event (D) in the propensity-matched cohort of patients receiving direct oral anticoagulant agents (DOACs) vs warfarin. The Aalen-Johansen method was used. This analysis demonstrated that anticoagulant agent type was not significantly associated with CVA, ICH, GIB, or any event.

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  Central Illustration. Comparison of Anticoagulation for Nonvalvular Atrial Fibrillation in Patients With Active Cancer Overall results comparing outcomes of cerebrovascular accident (CVA), intracranial hemorrhage (ICH), and gastrointestinal bleeding (GIB) in patients with active cancer and nonvalvular atrial fibrillation (NVAF) receiving warfarin compared with direct oral anticoagulant agents (DOACs) in a single-center retrospective cohort study using propensity-matched cohorts compared with Fine-Gray models. There was similar risk for CVA (subdistribution HR: 0.74; 95% CI: 0.34-1.63), ICH (subdistribution HR: 0.30; 95% CI: 0.03-2.71), GIB (subdistribution HR: 1.82; 95% CI: 0.77-4.28), and the composite event of CVA, ICH, or GIB (subdistribution HR: 1.15; 95% CI: 0.65-2.05) when comparing patients receiving warfarin and those receiving DOACs. Given the similar efficacy and adverse event profile of DOACs and warfarin for NVAF, they should be considered for use in patients with active cancer.