Clinical Outcomes in Atrial Fibrillation Patients With a History of Cancer Treated With Non-Vitamin K Antagonist Oral Anticoagulants A Nationwide Cohort Study

被引：25

作者：

Chan, Yi-Hsin ^{[1
,2
,6
]}

Chao, Tze-Fan ^{[11
,12
]}

Lee, Hsin-Fu ^{[3
,6
,7
]}

Chen, Shao-Wei ^{[4
,6
,8
]}

Li, Pei-Ru ^{[9
]}

Liu, Jia-Rou ^{[9
]}

Wu, Lung-Sheng ^{[1
,6
]}

Chang, Shang-Hung ^{[1
,5
,6
]}

Yeh, Yung-Hsin ^{[1
,6
]}

Kuo, Chi-Tai ^{[1
,6
]}

See, Lai-Chu ^{[9
,10
]}

Lip, Gregory Y. H. ^{[13
,14
]}

机构：

[1] Chang Gung Mem Hosp, Cardiovasc Dept, Linkou, Taiwan

[2] Chang Gung Mem Hosp, Microscopy Core Lab, Linkou, Taiwan

[3] Chang Gung Mem Hosp, New Taipei City Municipal Tucheng Hosp, Linkou, Taiwan

[4] Chang Gung Mem Hosp, Div Thorac & Cardiovasc Surg, Dept Surg, Linkou, Taiwan

[5] Chang Gung Mem Hosp, Ctr Big Data Analyt & Stat, Linkou, Taiwan

[6] Chang Gung Univ, Coll Med, Taoyuan, Taiwan

[7] Chang Gung Univ, Grad Inst Clin Med Sci, Coll Med, Taoyuan, Taiwan

[8] Chang Gung Univ, Linkou Med Ctr, Taoyuan, Taiwan

[9] Chang Gung Univ, Dept Publ Hlth, Coll Med, Taoyuan, Taiwan

[10] Chang Gung Univ, Biostat Core Lab, Mol Med Res Ctr, Taoyuan, Taiwan

[11] Taipei Vet Gen Hosp, Div Cardiol, Dept Med, Taipei, Taiwan

[12] Natl Yang Ming Chiao Tung Univ, Inst Clin Med, Cardiovasc Res Ctr, Taipei, Taiwan

[13] Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England

[14] Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England

来源：

STROKE | 2021年 / 52卷 / 10期

关键词：

atrial fibrillation; dabigatran; ischemic stroke; venous thrombosis; warfarin; RISK STRATIFICATION; WARFARIN; STROKE; SCORE; AF; THROMBOEMBOLISM; MANAGEMENT; HEMORRHAGE; EFFICACY; INSIGHTS;

D O I：

10.1161/STROKEAHA.120.033470

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose: Data on clinical outcomes for nonvitamin K antagonist oral anticoagulant (NOACs) and warfarin in patients with atrial fibrillation and cancer are limited, and patients with active cancer were excluded from randomized trials. We investigated the effectiveness and safety for NOACs versus warfarin among patients with atrial fibrillation with cancer. Methods: In this nationwide retrospective cohort study from Taiwan National Health Insurance Research Database, we identified a total of 6274 and 1681 consecutive patients with atrial fibrillation with cancer taking NOACs and warfarin from June 1, 2012, to December 31, 2017, respectively. Propensity score stabilized weighting was used to balance covariates across study groups. Results: There were 1031, 1758, 411, and 3074 patients treated with apixaban, dabigatran, edoxaban, and rivaroxaban, respectively. After propensity score stabilized weighting, NOAC was associated with a lower risk of major adverse cardiovascular events (hazard ratio, 0.63 [95% CI, 0.50-0.80]; P=0.0001), major adverse limb events (hazard ratio, 0.41 [95% CI, 0.24-0.70]; P=0.0010), venous thrombosis (hazard ratio, 0.37 [95% CI, 0.23-0.61]; P<0.0001), and major bleeding (hazard ratio, 0.73 [95% CI, 0.56-0.94]; P=0.0171) compared with warfarin. The outcomes were consistent with either direct thrombin inhibitor (dabigatran) or factor Xa inhibitor (apixaban, edoxaban, and rivaroxaban) use, among patients with stroke history, and among patients with different type of cancer and local, regional, or metastatic stage of cancer (P interaction >0.05). When compared with warfarin, NOAC was associated with lower risk of major adverse cardiovascular event, and venous thrombosis in patients aged <75 but not in those aged >= 75 years (P interaction <0.05). Conclusions: Thromboprophylaxis with NOACs rather than warfarin should be considered for the majority of the atrial fibrillation population with cancer.

引用

页码：3132 / 3141

页数：10

共 29 条

[1] Efficacy and Safety of Nonvitamin K Oral Anticoagulants in Patients with Atrial Fibrillation and Cancer: A Study-Level Meta-Analysis [J].