Key result
Oral anticoagulant initiation in patients with AF and active cancer rose ~4.3-fold from 2010 to 2023.
Why the study?
Anticoagulation is essential in patients with AF and cancer, but recent real-world evidence on oral anticoagulant prescribing trends and factors associated with initiation in UK primary care remains limited.
Cohort (n=12,254)
Yes
Relative Risk: 4.32 (95% CI 3.78–4.93)
Absolute Event Rate: 385% vs 89%
Oral anticoagulant initiation among UK primary care patients with atrial fibrillation and active cancer increased more than fourfold from 2010 to 2023 due to direct oral anticoagulant uptake, though prescribing gaps persist in those with lung cancer, metastatic disease, or dementia.
Rising OAC initiation in AF with active cancer merits monitoring; extends real-world DOAC trends but leaves net benefit open in subgroups.
BACKGROUND: Anticoagulation is essential in patients with atrial fibrillation (AF) and cancer, but recent real-world evidence on oral anticoagulant (OAC) use remains limited. OBJECTIVES: This study aims to describe recent OAC-prescribing trends and identify factors associated with OAC initiation in patients with AF and active cancer in UK primary care. METHODS: Using the Clinical Practice Research Datalink, we identified patients aged ≥50 years with incident AF (cohort entry) between 2010 and 2023 and active cancer diagnosed in the year before cohort entry. We calculated OAC initiation rates in the year following AF diagnosis among eligible patients (CHA RESULTS: Among 12,254 eligible patients, 6,940 (56.6%) initiated an OAC. OAC initiation rates rose from 89 per 100 person-years in 2010 to 385 per 100 person-years in 2023 (adjusted rate ratio: 4.32; 95% CI: 3.78-4.93), driven by increased direct oral anticoagulant prescribing. By 2023, apixaban and edoxaban predominated. OAC initiation did not differ by age and sex but was less common in patients with lung cancer (HR: 0.74; 95% CI: 0.67-0.82), metastatic cancer (HR: 0.66; 95% CI: 0.51-0.87), and dementia (HR: 0.75; 95% CI: 0.64-0.88). CONCLUSIONS: In the last decade, OAC initiation has substantially increased among eligible patients with AF and active cancer, driven by direct oral anticoagulant uptake. However, OAC initiation remained lower among patients with lung cancer, metastatic cancer, or specific comorbidities.
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Damba et al. (2026) conducted a cohort in Atrial fibrillation and active cancer (n=12,254). Oral anticoagulant (OAC) prescribing trends (2023 vs 2010) vs. 2010 baseline prescribing rates was evaluated on Oral anticoagulant initiation rate in the year following AF diagnosis (RR 4.32, 95% CI 3.78-4.93). Oral anticoagulant initiation in patients with AF and active cancer rose from 89 to 385 per 100 person-years between 2010 and 2023 (RR 4.32; 95% CI 3.78-4.93).
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