Net benefit of oral anticoagulants in patients with atrial fibrillation and active cancer: a nationwide cohort study. Issue 1 (21st November 2019)

• Record Type: Journal Article
• Authors: Atterman, Adriano; Friberg, Leif; Asplund, Kjell; Engdahl, Johan
• Is Part Of: Europace. Volume 22:Issue 1(2020)
• Page Start: 58
• Page End: 65
• Publication Date: 2019-11-21
• Subjects: Atrial fibrillation -- Anticoagulation -- Cancer -- Stroke -- Bleeding -- CHA2DS2-VASc; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euz306
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: To estimate the net cerebrovascular benefit of prophylactic treatment with oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and active cancer. Methods and results: We included all Swedish patients who had been diagnosed with AF in a hospital or in a hospital-associated outpatient unit between 1 July 2005 and 1 October 2017. Patients with active cancer ( n = 22 596) and without cancer ( n = 440 848) were propensity score matched for the likelihood of receiving OACs at baseline. At baseline, 38.3% of cancer patients with AF and high stroke risk according to CHA2 DS2 -VASc score received OACs. There was a net benefit of OACs, assessed by the composite outcome of ischaemic stroke, extracranial arterial thromboembolism, all major bleedings, and death, both among patients with active cancer [hazard ratio (HR): 0.81, confidence interval (CI): 0.78–0.85] and among patients without cancer (HR: 0.81, CI: 0.80–0.82). When limiting follow-up to 1 year to minimize the effects of possible treatment cross-over and additionally accounting for death as a competing risk in cancer patients, a net cerebrovascular benefit regarding ischaemic stroke or intracranial bleeding was observed for OACs [subhazard ratio (sHR): 0.67, CI: 0.55–0.83]. A net cerebrovascular benefit was also seen for non-vitamin K antagonist OACs over warfarin after competing risk analyses in cancer patients (sHR: 0.65, CI: 0.48–0.88). Conclusion: Patients with AF and active cancer benefit from OAC treatment.