Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients With Active Cancer
| Autor: | Gregory Y.H. Lip, Allison Keshishian, Christian Klem, Amol D Dhamane, Huseyin Yuce, Steven Deitelzweig, Jenny Jiang, Amiee Kang, Xuemei Luo, Mauricio Ferri, Yan Zhang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
anticoagulants PSM propensity score matching AF atrial fibrillation ICH intracranial hemorrhage VTE venous thromboembolism active cancer Internal medicine medicine NOAC non–vitamin K antagonist oral anticoagulant Stroke Original Research MB major bleeding NVAF nonvalvular atrial fibrillation AF - Atrial fibrillation business.industry SE systemic embolism nonvalvular atrial fibrillation Cancer Atrial fibrillation medicine.disease bleeding GI gastrointestinal stroke Clinical trial Oncology Cardiology GU genitourinary Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC: CardioOncology Deitelzweig, S, Keshishian, A V, Zhang, Y, Kang, A, Dhamane, A D, Luo, X, Klem, C, Ferri, M, Jiang, J, Yuce, H & Lip, G Y H 2021, ' Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients With Active Cancer ', JACC: CardioOncology, vol. 3, no. 3, pp. 411-424 . https://doi.org/10.1016/j.jaccao.2021.06.004 |
| ISSN: | 2666-0873 |
| DOI: | 10.1016/j.jaccao.2021.06.004 |
| Popis: | 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. Central Illustration |
| Databáze: | OpenAIRE |
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