Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients With Active Cancer

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New study below [1].

Background

Patients with cancer are more likely to develop nonvalvular atrial fibrillation (NVAF). Currently there are no definitive clinical trials or treatment guidelines for NVAF patients with concurrent cancer.

Objectives

This subgroup analysis of the ARISTOPHANES study compared the risk of stroke/systemic embolism (stroke/SE) and major bleeding (MB) among NVAF patients with active cancer who were prescribed non–vitamin K antagonist oral anticoagulants (NOACs) or warfarin.

Methods

A retrospective observational study was conducted in NVAF patients with active cancer who newly initiated apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, through September 30, 2015, with the use of Medicare and 4 U.S. commercial claims databases. Cox models were used to estimate the risk of stroke/SE and MB in the pooled propensity score–matched cohorts.

Results

A total of 40,271 patients were included, with main cancer types of prostate (29%), ...).

Compared with warfarin, apixaban was associated with a lower risk of stroke/SE (hazard ratio [HR]: 0.59 ...) and MB (HR: 0.58 ...; dabigatran and rivaroxaban had similar risks of stroke/SE (dabigatran: HR: 0.88 ...; rivaroxaban: HR: 0.82 ...) and MB (dabigatran: HR: 0.76 [95% CI: 0.57-1.01]; rivaroxaban: HR: 0.95 ...).

Risks of stroke/SE and MB varied among NOAC-NOAC comparisons, while consistent treatment effects were seen for all treatment comparisons across key cancer types.

Conclusions

Among this cohort of NVAF patients with active cancer, the risk of stroke/SE and MB varied among oral anticoagulants and were consistent across cancer types.

-Patrick

[1] ncbi.nlm.nih.gov/pmc/articl...

JACC CardioOncol. 2021 Sep; 3(3): 411–424.

Published online 2021 Sep 21. doi: 10.1016/j.jaccao.2021.06.004

Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients With Active Cancer

Steven Deitelzweig, MD,a,b,∗ Allison V. Keshishian, MPH,c,d Yan Zhang, PhD,e Amiee Kang, MPH,e Amol D. Dhamane, MS,e Xuemei Luo, PhD,f Christian Klem, PharmD,e Mauricio Ferri, MD,e Jenny Jiang, MS,e Huseyin Yuce, PhD,d and Gregory Y.H. Lip, MDg,h

aOchsner Clinic Foundation, Department of Hospital Medicine, New Orleans, Louisiana, USA

bUniversity of Queensland School of Medicine—Ochsner Clinical School, New Orleans, Louisiana, USA

cSTATinMED Research, Ann Arbor, Michigan, USA

dNew York City College of Technology, City University of New York, New York, New York, USA

eBristol Myers Squibb Company, Lawrenceville, New Jersey, USA

fPfizer, Inc., Groton, Connecticut, USA

gLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom

hAalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Steven Deitelzweig: gro.renshco@giewzletieds

∗Address for correspondence: Dr Steven Deitelzweig, Ochsner Health 1514 Jefferson Highway, 11th floor, Hospital Medicine, New Orleans, Louisiana 70121, USA. gro.renshco@giewzletieds, @statinmedresearchSee editorial "Direct Oral Anticoagulants in Patients With Cancer and Nonvalvular Atrial Fibrillation" in volume 3 on page 425.

Associated Data

Supplementary Materials

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Abstract

Background

Patients with cancer are more likely to develop nonvalvular atrial fibrillation (NVAF). Currently there are no definitive clinical trials or treatment guidelines for NVAF patients with concurrent cancer.

Objectives

This subgroup analysis of the ARISTOPHANES study compared the risk of stroke/systemic embolism (stroke/SE) and major bleeding (MB) among NVAF patients with active cancer who were prescribed non–vitamin K antagonist oral anticoagulants (NOACs) or warfarin.

Methods

A retrospective observational study was conducted in NVAF patients with active cancer who newly initiated apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, through September 30, 2015, with the use of Medicare and 4 U.S. commercial claims databases. Cox models were used to estimate the risk of stroke/SE and MB in the pooled propensity score–matched cohorts.

Results

A total of 40,271 patients were included, with main cancer types of prostate (29%), female breast (17%), genitourinary (14%), and lung (13%). Compared with warfarin, apixaban was associated with a lower risk of stroke/SE (hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.45-0.78) and MB (HR: 0.58; 95% CI: 0.50-0.68); dabigatran and rivaroxaban had similar risks of stroke/SE (dabigatran: HR: 0.88 [95% CI: 0.54-1.41]; rivaroxaban: HR: 0.82 [95% CI: 0.62-1.08]) and MB (dabigatran: HR: 0.76 [95% CI: 0.57-1.01]; rivaroxaban: HR: 0.95 [95% CI: 0.85-1.06]). Risks of stroke/SE and MB varied among NOAC-NOAC comparisons, while consistent treatment effects were seen for all treatment comparisons across key cancer types.

Conclusions

Among this cohort of NVAF patients with active cancer, the risk of stroke/SE and MB varied among oral anticoagulants and were consistent across cancer types.