Direct oral anticoagulants (DOACs) reduced all-cause mortality by 53% (HR 0.470) and cardiovascular events by 34% (HR 0.657) versus warfarin in AF patients with cancer.
Does the use of direct oral anticoagulants reduce all-cause mortality and cardiovascular events compared to warfarin in patients with atrial fibrillation and cancer?
In patients with atrial fibrillation and cancer, the use of DOACs is associated with significantly lower risks of all-cause mortality and cardiovascular events compared to warfarin.
Absolute Event Rate: 0% vs 0%
Abstract Background The management of atrial fibrillation (AF) in cancer patients remains an ongoing clinical challenge due to a higher risk for thromboembolic events. For this reason, these patients are often left untreated or prescribed on heparin. Aims of our study were: to investigate the all-cause mortality and cardiovascular events (CVEs) risk in AF patients with cancer comparing the use of direct oral anticoagulants (DOACs) and warfarin. Methods We performed a sub-analysis of the nationwide Italian START registry including only AF patients with cancer on treatment anticoagulants. Patients were grouped into 1) no cancer, 2) previous cancer and 3) active cancer. Results of the multivariable Cox stepwise regression analysis were expressed as hazard ratio (HR) and its 95% confidence interval (95%CI) Results 1,605 patients with AF and either active or previous cancer were included in the analysis. Overall, 292 (18.2%) had active cancer with the most prevalent being haematological (27.4%) and genitourinary (22.6%). Mean age was 77.7±8.0 years and 45.3% were women. During a median follow-up of 729.8 days±597.4 days 153 deaths and 177 CVEs occurred. At multivariable stepwise Cox analysis patients with active cancer had an increased risk of death (HR 1.825, 95%CI 1.269–2.623, p 0.001) and CVEs (HR 1.734, 95%CI 1.229–2.447, p= 0.002) compared to ones with previous cancer. In addition, we found that DOACs were associated with lower all-cause mortality (HR: 0.470, 95%CI: 0.327–0.675, p 0.001) and CVEs (HR 0.657, 95%CI 0.482-0.895, p= 0.008) compared to warfarin. At univariable Cox regression analysis, we found that Apixaban (HR: 0.535, 95% CI: 0.421–0.679, p 0.001), Rivaroxaban (HR: 0.564, 95% CI: 0.436–0.729, p 0.001), Edoxaban (HR: 0.502, 95% CI: 0.346–0.730, p 0.001), and Dabigatran (HR: 0.421, 95% CI: 0.315–0.562, p 0.001) were associated with a lower all-cause mortality risk compared to warfarin. Similar results were found about CVEs, showing a risk reduction in patients treated with Apixaban (HR 0.689, 95%CI 0.559-0.850, p0.001), Rivaroxaban (HR 0.691, 95%CI 0.550-0.870, p0.001), Edoxaban (HR 0.671, 95%CI 0.486-0.928, p=0.016) and Dabigatran (HR 0.595, 95%CI 0.467-0.757, p0.001). Conclusion In conclusions, DOACs seem to be associated with a lower mortality and CVEs compared to VKAs in patients with AF and cancer, independently from the DOAC prescribed. DOACs may represent an optimal choice in AF patients with cancer.VKAs vs DOACS: all-cause death VKAs vs DOACs: cardiovascular events
Cormaci et al. (Sat,) reported a other. Direct oral anticoagulants (DOACs) reduced all-cause mortality by 53% (HR 0.470) and cardiovascular events by 34% (HR 0.657) versus warfarin in AF patients with cancer.