Efficacy and safety of rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation and a history of cancer: observations from ROCKET AF

Chen, Sean T.; Hellkamp, Anne S.; Becker, Richard C.; Berkowitz, Scott D.; Breithardt, Günter; Fox, Keith; Hacke, Werner; Halperin, Jonathan L.; Hankey, Graeme J.; Mahaffey, Kenneth W.; Nessel, Christopher C.; Piccini, Jonathan P.; Singer, Daniel E.; Patel, Manesh R.; Melloni, Chiara

doi:10.1093/ehjqcco/qcy040

Cited by 98 publications

(119 citation statements)

References 23 publications

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…However, secondary analyses of these studies in patients with or without a history of cancer or in patients who developed cancer after enrollment have shed some light on DOAC use in the cancer population. In the ROCKET AF study, the efficacy and safety of rivaroxaban and warfarin in 460 patients with history of cancer were similar to those in patients without cancer . In the ATRISTOLE study, the safety and efficacy advantages of apixaban over warfarin in patients without a history of cancer were preserved in those with a cancer history .…”

Section: Introductionmentioning

confidence: 94%

Anticoagulation of cancer patients with non‐valvular atrial fibrillation receiving chemotherapy: Guidance from the SSC of the ISTH

Delluc

Wang

Yap

et al. 2019

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 94%

Anticoagulation of cancer patients with non‐valvular atrial fibrillation receiving chemotherapy: Guidance from the SSC of the ISTH

Delluc

Wang

Yap

et al. 2019

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

“…However, these recommendations cannot be extended to AF patients with malignances because in randomized clinical trials (RCTs) of DOACs for stroke and systemic embolism prevention in AF, cancer patients were underrepresented. Nevertheless, posthoc analyses of RCTs of DOACs [14][15][16][17] and retrospective population or cohort studies [18][19][20][21][22][23] have shown promising results of DOACs compared to VKAs in non-valvular AF patients with cancer. Therefore, we aimed to systematically assess the available evidences in the literature regarding the safety and efficacy of DOACs in comparison to VKAs in patients affected by non-valvular AF and cancer.…”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta-analysis

Mariani

Magnocavallo

Straito

et al. 2020

J Thromb Thrombolysis

View full text Add to dashboard Cite

Background Direct oral anticoagulants (DOACs) are recommended as first-line anticoagulants in patients with atrial fibrillation (AF). However, in patients with cancer and AF the efficacy and safety of DOACs are not well established. Objective We performed a meta-analysis comparing available data regarding the efficacy and safety of DOACs vs vitamin K antagonists (VKAs) in cancer patients with non-valvular AF. Methods An online search of Pubmed and EMBASE libraries (from inception to May, 1 2020) was performed, in addition to manual screening. Nine studies were considered eligible for the meta-analysis involving 46,424 DOACs users and 182,797 VKA users. Results The use of DOACs was associated with reduced risks of systemic embolism or any stroke (RR 0.65; 95% CI 0.52–0.81; p 0.001), ischemic stroke (RR 0.84; 95% CI 0.74–0.95; p 0.007) and hemorrhagic stroke (RR 0.61; 95% CI 0.52–0.71; p 0.00001) as compared to VKA group. DOAC use was associated with significantly reduced risks of major bleeding (RR 0.68; 95% CI 0.50–0.92; p 0.01) and intracranial or gastrointestinal bleeding (RR 0.64; 95% CI 0.47–0.88; p 0.006). Compared to VKA, DOACs provided a non-statistically significant risk reduction of the outcomes major bleeding or non-major clinically relevant bleeding (RR 0.94; 95% CI 0.78–1.13; p 0.50) and any bleeding (RR 0.91; 95% CI 0.78–1.06; p 0.24). Conclusions In comparison to VKA, DOACs were associated with a significant reduction of the rates of thromboembolic events and major bleeding complications in patients with AF and cancer. Further studies are needed to confirm our results.

show abstract

“…The prevalence of genitourinary varied from 27.14% of the ENGAGE-AF 17 to 40.8% in the ROCKET-AF. 15 GI tract cancer ranged from 16.18% in the ARIS-TOTLE 16 to 33.21% of the ENGAGE-AF population. 17 In the Mar-ketScan analysis, 18 lung cancer was present in 13.1%, GI in 13.9% and genitourinary in 28.7%, this latter proportion being similar to the present study.…”

Section: Discussionmentioning

confidence: 99%

Cancer‐specific ischemic complications in elderly patients with atrial fibrillation: Data from the prospective ATHERO‐AF study

Pastori

Menichelli

Bucci

et al. 2020

Intl Journal of Cancer

View full text Add to dashboard Cite

Cancer may complicate the clinical course of nonvalvular atrial fibrillation (AF) but its association with cardiovascular events (CVEs) remains unclear. We performed a prospective cohort study including 2092 consecutive AF patients on vitamin K antagonists. Principal endpoint was the occurrence of CVEs including fatal/nonfatal myocardial infarction and ischemic stroke/transient ischemic attack and cardiovascular death. Secondary endpoints were major adverse cardiac events (MACEs) and thromboembolism (TE). Mean age was 73.7 ± 9.1 years and 42.1% were women; 367 (17.5%) patients had cancer: 21% gastrointestinal (GI), 10% respiratory, 28% genitourinary and 41% had other localization. Cancer patients were older but with similar comorbidities than those without. During a mean of 35.9 months, 203 CVEs occurred (incidence rate [IR] = 3.24 per 100 patient-years): 133 MACEs (IR = 2.12 per 100 patient-years) and 70 TE (IR = 1.12 per 100 patient-years). Multivariable Cox proportional hazards regression analysis showed an association between GI cancer and MACE occurrence (hazard ratio [HR] = 3.22, 95% confidence interval [CI] = 1.59-6.52, P = .001) and between respiratory cancer and TE (HR = 3.37, 95% CI = 1.30-8.75, P = .013). These associations were confirmed at competing risk analysis. In conclusion, AF patients with cancer have specific vascular outcomes according to cancer site, as indicated by the higher risk of MACE and TE in patients with gastrointestinal and respiratory cancer, respectively.

show abstract

Efficacy and safety of rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation and a history of cancer: observations from ROCKET AF

Cited by 98 publications

References 23 publications

Anticoagulation of cancer patients with non‐valvular atrial fibrillation receiving chemotherapy: Guidance from the SSC of the ISTH

Anticoagulation of cancer patients with non‐valvular atrial fibrillation receiving chemotherapy: Guidance from the SSC of the ISTH

Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta-analysis

Cancer‐specific ischemic complications in elderly patients with atrial fibrillation: Data from the prospective ATHERO‐AF study

Contact Info

Product

Resources

About