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Superior safety of direct oral anticoagulants compared to Warfarin in patients with atrial fibrillation and underlying cancer: a national veterans affairs database study

BACKGROUND: Studies evaluating safety of warfarin and direct oral anticoagulants (DOACs) for prevention of stroke in patients with atrial fibrillation (AF) are lacking. METHODS & RESULTS: All patients (n = 196,521) receiving care at veteran's affairs with active cancer and AF from 2010–2015...

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Detalles Bibliográficos
Autores principales: Sawant, Abhishek C, Kumar, Arnav, Mccray, Wilmon, Tetewsky, Sheldon, Parone, Linda, Sridhara, Srilekha, Prakash, Meghana Prakash Hiriyur, Tse, Gary, Liu, Tong, Kanwar, Nidhi, Bhardwaj, Aishwarya, Khan, Sahoor, Manion, Christopher, Lahoti, Ankush, Pershad, Ashish, Elkin, Peter, Corbelli, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Science Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790962/
https://www.ncbi.nlm.nih.gov/pubmed/31645857
http://dx.doi.org/10.11909/j.issn.1671-5411.2019.09.006
Descripción
Sumario:BACKGROUND: Studies evaluating safety of warfarin and direct oral anticoagulants (DOACs) for prevention of stroke in patients with atrial fibrillation (AF) are lacking. METHODS & RESULTS: All patients (n = 196,521) receiving care at veteran's affairs with active cancer and AF from 2010–2015 were included. One-year mortality was significantly higher in unadjusted analysis with warfarin (44.9%) compared to dabigatran (25%, P < 0.001), rivaroxaban (24.4%, P < 0.001) and apixaban (30%, P < 0.001) and after adjusting for age, sex and type of cancer mortality (OR = 2.66, 95% CI: 2.52–2.82, P < 0.001). Risk of ischemic stroke (13.5% vs. 11.1%, 12.0%, 14.0%) was similar, however risk of hemorrhagic stroke was significantly higher among patients receiving warfarin (1.2%) compared to patients receiving dabigatran (0.5%), rivaroxaban (0.7%) and apixaban (0.8%) respectively, P = 0.04. CONCLUSIONS: We demonstrated the superior safety profile of DOACs compared to warfarin among patients with underlying cancer and AF. Warfarin was associated with higher mortality, similar ischemic stroke risk but higher risk of hemorrhagic stroke.