Oral Anticoagulants in Japanese Patients with Atrial Fibrillation and Active Cancer

Abstract

Objective Oral anticoagulants (OACs), which include direct oral anticoagulants (DOACs) and warfarin, are widely used for the prevention of thromboembolic events in patients with atrial fibrillation (AF). Cancer is associated with a prothrombotic state as well as an increased bleeding risk. Few data are available on the efficacy and safety of OACs in Japanese cancer patients with AF. We sought to investigate the efficacy and safety of OACs in this population. Methods This retrospective cohort study included active cancer patients in whom AF was recorded by electrocardiography in our hospital from January 2014 to December 2016 and who were treated with DOACs or warfarin. Patients were followed for 1 year. The study outcomes were stroke or systemic embolism and major bleeding. Result A total of 224 patients with AF and active cancer were treated with OACs (DOACs, n=127; warfarin, n=97). Overall, stroke or systemic embolism and major bleeding occurred in seven (3.8%/year) and eight (4.9%/year) patients, respectively. Stroke or systemic embolism occurred in three patients in the DOAC group (2.8%/year) and four patients in the warfarin group (5.4%/year). Major bleeding occurred in four patients in the DOAC group (4.0%/year) and four patients in the warfarin group (6.5%/year). Conclusion The rates of stroke or systemic embolism and major bleeding events were not negligible among Japanese cancer patients with AF receiving OACs. Further investigations on the optimal management of Japanese patients with AF and cancer are needed.

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

“…The more prevalent malignances across the studies were gastrointestinal, breast and prostatic cancers (Supplemental Material, Table S1). All the studies but three reported the propensity-score-matched or adjusted RRs [ 20 , 21 , 23 ] for pre-specified outcomes. In 7 out 9 studies, major bleedings were considered according to the ISTH criteria [ 24 ], whereas one study [ 20 ] reported any diagnosis of gastrointestinal, lung and urinary bleedings as safety outcomes.…”

“…After excluding duplicate publications, reviews, editorials, letters, meta-analysis, case reports and abstracts, 28 studies were fully reviewed and 9 studies were considered eligible for the meta-analysis. In particular, the studies used for the analysis included 3 post-hoc analysis from RCTs [14][15][16] and 6 retrospective population-based cohort studies [18][19][20][21][22][23] involving 46,424 DOACs users and 182,797 VKA users ( Table 1).…”

“…Among the retrospective population-based cohort studies, 4 out 6 reported the management of non-valvular AF in cancer patients taking apixaban, rivaroxaban and dabigatran [18][19][20][21]. The remaining retrospective studies Wu et al [22] and Yasui [23] included apixaban, rivaroxaban, dabigatran and edoxaban in the analysis.…”

“…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.…”

Prognostic Impact of Cancer Activity on Clinically Relevant Bleeding Events After Percutaneous Coronary Intervention: A Retrospective Study

“…Furthermore, cancer patients have higher bleeding risks when treated with anti-thrombotic drugs for venous thromboembolism [6]. An increased risk of bleeding due to anticoagulation therapy with direct oral anticoagulants (DOAC) or warfarin has been reported [7][8][9][10][11]. Percutaneous coronary intervention (PCI) with stent implantation, which requires extended treatment with dualantiplatelet therapy (DAPT) followed by single-antiplatelet therapy (SAPT), is often performed as treatment for CAD in cancer patients.…”