Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
06 07 2023
06 07 2023
Historique:
received:
24
01
2023
accepted:
02
07
2023
medline:
10
7
2023
pubmed:
7
7
2023
entrez:
6
7
2023
Statut:
epublish
Résumé
To date, evidence on optimal anticoagulant options in patients with AF who concurrently have active cancer remains elusive. To describe anticoagulant patterns and clinical outcomes among patients with a concomitant diagnosis of AF and cancer. Data were obtained from the University of Utah and Huntsman Cancer Institute (HCI) Hospitals. Patients were included if they had diagnosis of AF and cancer. Outcome was type and pattern of anticoagulant. Clinical outcomes were stroke, bleeding and all-cause mortality. From October 1999 to December 2020, there were 566 AF patients who concurrently had active cancer. Mean age ± standard deviation was 76.2 ± 10.7 and 57.6% were males. Comparing to warfarin, patients who received direct oral anticoagulant (DOACs) were associated with similar risk of stroke (adjusted hazard ratio, aHR 0.8, 95% confidence interval [CI] 0.2-2.7, P = 0.67). On contrary, those who received low-molecular-weight heparin (LMWH) were associated with significantly higher risk of stroke comparing to warfarin (aHR 2.4, 95% CI 1.0-5.6, P = 0.04). Comparing to warfarin, DOACs and LMWH was associated with similar risk of overall bleeding with aHR 1.1 (95% CI 0.7-1.6, P = 0.73) and aHR 1.1 (95% CI 0.6-1.7, P = 0.83), respectively. Patients who received LMWH but not DOACs were associated with increased risk of death as compared to warfarin, aHR 4.5 (95% CI 2.8-7.2, P < 0.001) and 1.2 (95% CI 0.7-2.2, P = 0.47). In patients with active cancer and AF, LMWH, compared to warfarin, was associated with an increased risk of stroke and all-cause mortality. Furthermore, DOACs was associated with similar risk of stroke, bleeding and death as compared to warfarin.
Identifiants
pubmed: 37414965
doi: 10.1038/s41598-023-38071-3
pii: 10.1038/s41598-023-38071-3
pmc: PMC10325995
doi:
Substances chimiques
Anticoagulants
0
Warfarin
5Q7ZVV76EI
Heparin, Low-Molecular-Weight
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
10937Informations de copyright
© 2023. The Author(s).
Références
J Am Heart Assoc. 2018 Aug 21;7(16):e008987
pubmed: 30369307
J Clin Oncol. 2018 Jul 10;36(20):2017-2023
pubmed: 29746227
Ann Intern Med. 2013 Mar 5;158(5 Pt 1):338-46
pubmed: 23460057
Europace. 2021 Oct 9;23(10):1612-1676
pubmed: 33895845
Blood Adv. 2021 Feb 23;5(4):927-974
pubmed: 33570602
Ann Transl Med. 2018 Apr;6(7):121
pubmed: 29955581
Eur J Intern Med. 2019 Jan;59:27-33
pubmed: 30385084
J Epidemiol. 2020 Sep 5;30(9):377-389
pubmed: 32684529
JAMA Intern Med. 2014 Jan;174(1):107-14
pubmed: 24190540
Lancet. 2015 Jul 11;386(9989):154-62
pubmed: 25960110
JACC CardioOncol. 2021 Jun 15;3(2):221-232
pubmed: 34396327
J Thromb Haemost. 2005 Apr;3(4):692-4
pubmed: 15842354
Nat Rev Cardiol. 2014 Nov;11(11):639-54
pubmed: 25113750
JACC CardioOncol. 2020 Dec 15;2(5):747-754
pubmed: 34396290
JAMA. 2001 May 9;285(18):2370-5
pubmed: 11343485
N Engl J Med. 2020 Apr 23;382(17):1599-1607
pubmed: 32223112
Am J Med. 2017 Dec;130(12):1440-1448.e1
pubmed: 28739198
Circulation. 2014 Feb 25;129(8):837-47
pubmed: 24345399
Rev Esp Cardiol (Engl Ed). 2019 Sep;72(9):749-759
pubmed: 31405794
J Thromb Haemost. 2015 Jan;13(1):10-6
pubmed: 25330989
N Engl J Med. 2018 Jul 05;379(1):95-96
pubmed: 29972743
JAMA Netw Open. 2021 Feb 1;4(2):e2036304
pubmed: 33533929