J Cancer 2020; 11(1):92-99. doi:10.7150/jca.36468 This issue

Research Paper

Novel Oral Anticoagulant versus Warfarin in Cancer Patients with Atrial Fibrillation: An 8-Year Population-Based Cohort Study

Victor Chien-Chia Wu1,2, Chun-Li Wang1,2, Yu-Tung Huang3,4, Wen-Ching Lan3, Michael Wu5, Chang-Fu Kuo2,6,7, Shao-Wei Chen8, Pao-Hsien Chu1,2, Ming-Shien Wen1,2, Chi-Ching Kuo9, Shang-Hung Chang1,2,3,4✉

1. Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
2. College of Medicine, Chang Gung University, Taoyuan City, Taiwan
3. Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
4. Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
5. Divison of Cardiovascular Medicine, Arrhythmia Services Section, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, USA
6. Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
7. Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
8. Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
9. Institute of Organic and Polymeric Materials, National Taipei University of Technology, Taipei, Taiwan.

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Citation:
Wu VCC, Wang CL, Huang YT, Lan WC, Wu M, Kuo CF, Chen SW, Chu PH, Wen MS, Kuo CC, Chang SH. Novel Oral Anticoagulant versus Warfarin in Cancer Patients with Atrial Fibrillation: An 8-Year Population-Based Cohort Study. J Cancer 2020; 11(1):92-99. doi:10.7150/jca.36468. Available from https://www.jcancer.org/v11p0092.htm

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Abstract

Background: Cancer patients with atrial fibrillation (AF) were excluded in the major clinical trials. We therefore investigated the efficacy and safety of novel oral anticoagulant (NOAC) versus warfarin in these patients.

Methods: Data were retrieved from Taiwan National Health Insurance Research Database during 2010-2017 for patients with AF, excluding those without cancer or >1 cancer, not using anticoagulant, switching of agents, patients age <18, and cancer and AF diagnosed >1 month apart. Primary outcomes are ischemic stroke (IS)/systemic embolism (SE), GI bleeding, major bleeding, intracranial hemorrhage (ICH), acute myocardial infarction (AMI), and death from any cause at 6 months and 1 year.

Results: After exclusion criteria and propensity score matching, there were 336 patients in each group. Patients on NOAC had significantly reduced IS/SE (HR=0.45, 95% CI=0.25-0.82), major bleeding (HR=0.21, 95% CI=0.05-0.96), and no ICH at 6 months. In addition, IS/SE (HR=0.42, 95% CI=0.24-0.74), major bleeding (HR=0.26, 95% CI=0.09-0.76), and no ICH at 1 year compared to patients on warfarin. There was no difference on GI bleeding, AMI, and death from any cause at 6 months and at 1 year.

Conclusion: In cancer patients with AF, NOAC were associated with significant reduced IS/SE, major bleeding, and ICH compared to warfarin.

Keywords: anticoagulation, atrial fibrillation, cancer, NOAC, warfarin