Abstract
Aim To determine to what extent active cancer influences the benefit-risk relationship among patients with atrial fibrillation receiving oral anticoagulants for stroke prevention. Methods In this cohort study of all patients with atrial fibrillation in the Swedish Patient register during 2006 to 2017, 8,228 patients with active cancer and 323,394 without cancer were followed up to 1 year after initiation of oral anticoagulants. Cox regression models, adjusting for confounders and the competing risk of death, were used to assess risk of cerebrovascular and bleeding events. Results Among patients treated with oral anticoagulants, the risk for cerebrovascular events did not differ between cancer patients and noncancer patients (subhazard ratio [sHR]: 1.12, 95% confidence interval [CI]: 0.98-1.29). Cancer patients had a higher risk for bleedings (sHR: 1.69, CI: 1.56-1.82), but not for fatal bleedings (sHR: 1.17, CI: 0.80-1.70). Use of nonvitamin K oral anticoagulants was associated with lower risk of both cerebrovascular events and bleedings compared with warfarin. Conclusion Patients with atrial fibrillation and active cancer appear to have similar net cerebrovascular benefit of oral anticoagulant treatment to patients without...Continue Reading
References
Aug 10, 2006·Pharmacoepidemiology and Drug Safety·Björn WettermarkMåns Rosén
Sep 4, 2008·Acta Oncologica·Lotti BarlowMats Talbäck
Sep 19, 2009·Chest·Gregory Y H LipHarry J G M Crijns
Nov 26, 2009·European Journal of Epidemiology·J Gustav SmithOlle Melander
Mar 20, 2010·Chest·Ron PistersGregory Y H Lip
Jun 11, 2011·BMC Public Health·Jonas F LudvigssonPetra Otterblad Olausson
Feb 1, 2013·Neuroepidemiology·Max KösterBirgitta Stegmayr
May 28, 2014·Thrombosis Research·Pieter W Kamphuisen, Jan Beyer-Westendorf
Nov 4, 2016·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Paulus KirchhofKatja Zeppenfeld
May 26, 2017·Cancer Medicine·Anne G OrdingHenrik T Sørensen
Oct 7, 2017·European Journal of Epidemiology·Hannah Louise BrookeRickard Ljung
Jun 6, 2018·Stroke; a Journal of Cerebral Circulation·Klaus Kaae Andersen, Tom Skyhøj Olsen
Sep 17, 2018·European Heart Journal. Quality of Care & Clinical Outcomes·Sean T ChenChiara Melloni
Oct 30, 2018·Journal of the American Heart Association·Christina L FanolaRobert P Giugliano
Feb 1, 2019·Heart Rhythm : the Official Journal of the Heart Rhythm Society·UNKNOWN Writing Group MembersClyde W Yancy
Mar 23, 2019·Journal of the American College of Cardiology·Ramya C MosarlaRobert P Giugliano
Jun 30, 2019·Scandinavian Cardiovascular Journal : SCJ·Maria D'SouzaEmil Fosbøl
Dec 1, 2019·Thrombosis and Haemostasis·Ilaria CavallariGiuseppe Patti
Jan 29, 2020·The Breast Journal·Antonis ValachisLars Holmberg
Apr 2, 2020·European Stroke Journal·Ramon Luengo-FernandezJose Leal