Cardio-Oncology Resource Center

Cardio-Oncology Resource Center

Disclosures: Chan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
July 22, 2021
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Non-vitamin K antagonist oral anticoagulants beneficial for patients with AF, cancer

Disclosures: Chan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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In patients with atrial fibrillation and cancer, non-vitamin K antagonist oral anticoagulants outperformed warfarin in thrombotic and bleeding endpoints, according to findings published in Stroke.

“Current international guidelines recommend the use of non-vitamin K antagonist oral anticoagulants as effective, safer and more convenient alternatives to warfarin among patients with nonvalvular AF, even in several difficult scenarios including those with old age, acute coronary syndrome, chronic kidney disease or easy frailty and fall,” Yi-Hsin Chan, MD, from the department of cardiology at the Microscopy Core Laboratory at Chang Gung Memorial Hospital College of Medicine in Linkou, Taiwan, and colleagues wrote. “However, whether these recommendations apply to patients with AF with cancer requires further data.”

Data were derived from Chan YH, et al. Stroke. 2021;doi:10.1161/STROKEAHA.120.033470.

The nationwide, retrospective, population-based cohort study assessed the Taiwan National Health Insurance Research Database from June 2012 to December 2017. Researchers identified 6,274 patients (mean age, 77 years; 58% men) with AF and cancer treated with non-vitamin K antagonist oral anticoagulants and 1,681 patients (mean age, 75 years; 58% men) with AF and cancer treated with warfarin.

In the cohort, the following non-vitamin K antagonist oral anticoagulants were used:

  • apixaban (Eliquis, Bristol Myers Squibb/Pfizer), 1,031 patients;
  • dabigatran (Pradaxa, Boehringer Ingelheim), 1,758 patients;
  • edoxaban (Savaysa, Daiichi Sankyo), 411 patients; and
  • rivaroxaban (Xarelto, Janssen/Bayer), 3,074 patients.

Compared with warfarin, non-vitamin K antagonist oral anticoagulants use was associated with lower risks for major adverse CV events (HR = 0.63; 95% CI, 0.5-0.8; P = .0001), major adverse limb events (HR = 0.41; 95% CI, 0.24-0.7; P = .001), venous thrombosis (HR = 0.37; 95% CI, 0.23-0.61; P < .0001) and major bleeding (HR = 0.73; 95% CI, 0.56-0.94; P = .0171).

The results remained consistent with use of direct thrombin inhibitors like dabigatran or factor Xa inhibitors like apixaban, edoxaban and rivaroxaban, among those with a history of stroke and among those with different types of cancer as well as local (n = 2,365), regional (n = 4,524) or metastatic (n = 1,066) cancer stages (P > .05).

According to the researchers, the results of this study are important in clinical practice because this patient population is underrepresented in clinical trials, especially if presenting with active cancer.

“The treatment benefit for non-vitamin K antagonist oral anticoagulants over warfarin persisted in patients treated with different non-vitamin K antagonist oral anticoagulants and in patients with remote or active cancer status, suggesting that thromboprophylaxis with non-vitamin K antagonist oral anticoagulants rather than warfarin should be considered for the majority of the AF population with cancer,” the researchers wrote.