Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers
Increasing clinical evidence supports the use of direct oral anticoagulants (DOACs) as a potential new therapeutic option for patients suffering from cancer-associated thromboembolism. However, the clinical impact of DOACs compared with traditional anticoagulants on the survival of patients with hea...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-01-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/3/703 |
| _version_ | 1797488707318579200 |
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| author | Chien-Lin Lee Wei-Shan Chen Yinshen Wee Ching-Shuen Wang Wei-Chih Chen Tai-Jan Chiu Yu-Ming Wang Ching-Nung Wu Yao-Hsu Yang Sheng-Dean Luo Shao-Chun Wu |
| author_facet | Chien-Lin Lee Wei-Shan Chen Yinshen Wee Ching-Shuen Wang Wei-Chih Chen Tai-Jan Chiu Yu-Ming Wang Ching-Nung Wu Yao-Hsu Yang Sheng-Dean Luo Shao-Chun Wu |
| author_sort | Chien-Lin Lee |
| collection | DOAJ |
| description | Increasing clinical evidence supports the use of direct oral anticoagulants (DOACs) as a potential new therapeutic option for patients suffering from cancer-associated thromboembolism. However, the clinical impact of DOACs compared with traditional anticoagulants on the survival of patients with head and neck cancer has not been well studied. A total of 1025 patients diagnosed as having head and neck cancer, including 92 DOAC users, 113 warfarin users, and 820 nonusers of anticoagulants, were selected from the Chang Gung Research Database between January 2001 and December 2019. The patients were matched using the propensity-score method. The survival rates were estimated among the three groups using the Kaplan–Meier method. The protective effects and side effects of the two anticoagulants were compared using the chi-square test. The death rate (18 patients, 19.57%) in patients using DOACs was significantly lower than that in patients using warfarin (68 patients, 60.18%) and those not using any anticoagulant (403 patients, 49.15%). DOAC users had significantly better disease-specific survival (DSS) than warfarin users (<i>p</i> = 0.019) and those who did not use any anticoagulant (<i>p</i> = 0.03). Further, DOAC users had significantly higher overall survival (OS) rates than warfarin users and those who did not use any anticoagulant (<i>p</i> = 0.003). Patients with oropharyngeal and laryngeal cancer and DOAC users had a significantly lower hazard ratio for survival, whereas patients with American Joint Committee on Cancer stage IV disease and those receiving multidisciplinary treatment (e.g., surgery with radiotherapy or concurrent radiochemotherapy) had a significantly higher hazard ratio for survival. Among them, patients with laryngeal cancer (HR = 0.47, 95% CI = 0.26–0.86, <i>p</i> = 0.0134) and DOAC users (HR = 0.53, 95% CI = 0.29–0.98, <i>p</i> = 0.042) had the lowest hazard ratio from DSS analysis. Similarly, patients with laryngeal cancer (HR = 0.48, 95% CI = 0.30–0.76, <i>p</i> = 0.0018) and DOAC users (HR = 0.58, 95% CI = 0.36–0.93, <i>p</i> = 0.0251) had the lowest hazard ratio from OS analysis. As for the protective effects or side effects of anticoagulants, there were no significant differences in the occurrence rate of bleeding or ischemic events between DOAC and warfarin users. In our study, DOACs were found to be better than warfarin in terms of survival in patients with head and neck cancer. As regards thromboembolism prevention and side effects, DOACs were comparable to warfarin in our patients. DOACs can be a treatment choice or prophylaxis for tumor emboli in head and neck cancer patients and they might be a better choice than traditional anticoagulants according to the results of our study. |
| first_indexed | 2024-03-10T00:06:09Z |
| format | Article |
| id | doaj.art-5184ebeb75bf44cb823b61681603d7c2 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T00:06:09Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-5184ebeb75bf44cb823b61681603d7c22023-11-23T16:07:16ZengMDPI AGCancers2072-66942022-01-0114370310.3390/cancers14030703Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck CancersChien-Lin Lee0Wei-Shan Chen1Yinshen Wee2Ching-Shuen Wang3Wei-Chih Chen4Tai-Jan Chiu5Yu-Ming Wang6Ching-Nung Wu7Yao-Hsu Yang8Sheng-Dean Luo9Shao-Chun Wu10Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Pathology, University of Utah, Salt Lake City, UT 84112, USASchool of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 613, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, TaiwanIncreasing clinical evidence supports the use of direct oral anticoagulants (DOACs) as a potential new therapeutic option for patients suffering from cancer-associated thromboembolism. However, the clinical impact of DOACs compared with traditional anticoagulants on the survival of patients with head and neck cancer has not been well studied. A total of 1025 patients diagnosed as having head and neck cancer, including 92 DOAC users, 113 warfarin users, and 820 nonusers of anticoagulants, were selected from the Chang Gung Research Database between January 2001 and December 2019. The patients were matched using the propensity-score method. The survival rates were estimated among the three groups using the Kaplan–Meier method. The protective effects and side effects of the two anticoagulants were compared using the chi-square test. The death rate (18 patients, 19.57%) in patients using DOACs was significantly lower than that in patients using warfarin (68 patients, 60.18%) and those not using any anticoagulant (403 patients, 49.15%). DOAC users had significantly better disease-specific survival (DSS) than warfarin users (<i>p</i> = 0.019) and those who did not use any anticoagulant (<i>p</i> = 0.03). Further, DOAC users had significantly higher overall survival (OS) rates than warfarin users and those who did not use any anticoagulant (<i>p</i> = 0.003). Patients with oropharyngeal and laryngeal cancer and DOAC users had a significantly lower hazard ratio for survival, whereas patients with American Joint Committee on Cancer stage IV disease and those receiving multidisciplinary treatment (e.g., surgery with radiotherapy or concurrent radiochemotherapy) had a significantly higher hazard ratio for survival. Among them, patients with laryngeal cancer (HR = 0.47, 95% CI = 0.26–0.86, <i>p</i> = 0.0134) and DOAC users (HR = 0.53, 95% CI = 0.29–0.98, <i>p</i> = 0.042) had the lowest hazard ratio from DSS analysis. Similarly, patients with laryngeal cancer (HR = 0.48, 95% CI = 0.30–0.76, <i>p</i> = 0.0018) and DOAC users (HR = 0.58, 95% CI = 0.36–0.93, <i>p</i> = 0.0251) had the lowest hazard ratio from OS analysis. As for the protective effects or side effects of anticoagulants, there were no significant differences in the occurrence rate of bleeding or ischemic events between DOAC and warfarin users. In our study, DOACs were found to be better than warfarin in terms of survival in patients with head and neck cancer. As regards thromboembolism prevention and side effects, DOACs were comparable to warfarin in our patients. DOACs can be a treatment choice or prophylaxis for tumor emboli in head and neck cancer patients and they might be a better choice than traditional anticoagulants according to the results of our study.https://www.mdpi.com/2072-6694/14/3/703direct oral anticoagulantswarfarinsurvivalhead and neck cancercancer-associated thromboembolism |
| spellingShingle | Chien-Lin Lee Wei-Shan Chen Yinshen Wee Ching-Shuen Wang Wei-Chih Chen Tai-Jan Chiu Yu-Ming Wang Ching-Nung Wu Yao-Hsu Yang Sheng-Dean Luo Shao-Chun Wu Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers Cancers direct oral anticoagulants warfarin survival head and neck cancer cancer-associated thromboembolism |
| title | Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers |
| title_full | Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers |
| title_fullStr | Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers |
| title_full_unstemmed | Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers |
| title_short | Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers |
| title_sort | direct oral anticoagulants are associated with superior survival outcomes than warfarin in patients with head and neck cancers |
| topic | direct oral anticoagulants warfarin survival head and neck cancer cancer-associated thromboembolism |
| url | https://www.mdpi.com/2072-6694/14/3/703 |
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