Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation
Abstract To date, evidence on optimal anticoagulant options in patients with AF who concurrently have active cancer remains elusive. To describe anticoagulant patterns and clinical outcomes among patients with a concomitant diagnosis of AF and cancer. Data were obtained from the University of Utah a...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-07-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-38071-3 |
| _version_ | 1797784659202932736 |
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| author | Chatree Chai-Adisaksopha Alexandre H. Watanabe Piyameth Dilokthornsakul Leenhapong Navaravong Daniel M. Witt Nathorn Chaiyakunapruk |
| author_facet | Chatree Chai-Adisaksopha Alexandre H. Watanabe Piyameth Dilokthornsakul Leenhapong Navaravong Daniel M. Witt Nathorn Chaiyakunapruk |
| author_sort | Chatree Chai-Adisaksopha |
| collection | DOAJ |
| description | Abstract To date, evidence on optimal anticoagulant options in patients with AF who concurrently have active cancer remains elusive. To describe anticoagulant patterns and clinical outcomes among patients with a concomitant diagnosis of AF and cancer. Data were obtained from the University of Utah and Huntsman Cancer Institute (HCI) Hospitals. Patients were included if they had diagnosis of AF and cancer. Outcome was type and pattern of anticoagulant. Clinical outcomes were stroke, bleeding and all-cause mortality. From October 1999 to December 2020, there were 566 AF patients who concurrently had active cancer. Mean age ± standard deviation was 76.2 ± 10.7 and 57.6% were males. Comparing to warfarin, patients who received direct oral anticoagulant (DOACs) were associated with similar risk of stroke (adjusted hazard ratio, aHR 0.8, 95% confidence interval [CI] 0.2–2.7, P = 0.67). On contrary, those who received low-molecular-weight heparin (LMWH) were associated with significantly higher risk of stroke comparing to warfarin (aHR 2.4, 95% CI 1.0–5.6, P = 0.04). Comparing to warfarin, DOACs and LMWH was associated with similar risk of overall bleeding with aHR 1.1 (95% CI 0.7–1.6, P = 0.73) and aHR 1.1 (95% CI 0.6–1.7, P = 0.83), respectively. Patients who received LMWH but not DOACs were associated with increased risk of death as compared to warfarin, aHR 4.5 (95% CI 2.8–7.2, P < 0.001) and 1.2 (95% CI 0.7–2.2, P = 0.47). In patients with active cancer and AF, LMWH, compared to warfarin, was associated with an increased risk of stroke and all-cause mortality. Furthermore, DOACs was associated with similar risk of stroke, bleeding and death as compared to warfarin. |
| first_indexed | 2024-03-13T00:43:03Z |
| format | Article |
| id | doaj.art-d9a26f68eccf487e85127d9821f026ef |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-13T00:43:03Z |
| publishDate | 2023-07-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj.art-d9a26f68eccf487e85127d9821f026ef2023-07-09T11:12:18ZengNature PortfolioScientific Reports2045-23222023-07-011311810.1038/s41598-023-38071-3Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillationChatree Chai-Adisaksopha0Alexandre H. Watanabe1Piyameth Dilokthornsakul2Leenhapong Navaravong3Daniel M. Witt4Nathorn Chaiyakunapruk5Department of Internal Medicine, Chiang Mai UniversityDepartment of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, University of UtahCenter for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai UniversityDivision of Cardiovascular Medicine, University of UtahDepartment of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, University of UtahDepartment of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, University of UtahAbstract To date, evidence on optimal anticoagulant options in patients with AF who concurrently have active cancer remains elusive. To describe anticoagulant patterns and clinical outcomes among patients with a concomitant diagnosis of AF and cancer. Data were obtained from the University of Utah and Huntsman Cancer Institute (HCI) Hospitals. Patients were included if they had diagnosis of AF and cancer. Outcome was type and pattern of anticoagulant. Clinical outcomes were stroke, bleeding and all-cause mortality. From October 1999 to December 2020, there were 566 AF patients who concurrently had active cancer. Mean age ± standard deviation was 76.2 ± 10.7 and 57.6% were males. Comparing to warfarin, patients who received direct oral anticoagulant (DOACs) were associated with similar risk of stroke (adjusted hazard ratio, aHR 0.8, 95% confidence interval [CI] 0.2–2.7, P = 0.67). On contrary, those who received low-molecular-weight heparin (LMWH) were associated with significantly higher risk of stroke comparing to warfarin (aHR 2.4, 95% CI 1.0–5.6, P = 0.04). Comparing to warfarin, DOACs and LMWH was associated with similar risk of overall bleeding with aHR 1.1 (95% CI 0.7–1.6, P = 0.73) and aHR 1.1 (95% CI 0.6–1.7, P = 0.83), respectively. Patients who received LMWH but not DOACs were associated with increased risk of death as compared to warfarin, aHR 4.5 (95% CI 2.8–7.2, P < 0.001) and 1.2 (95% CI 0.7–2.2, P = 0.47). In patients with active cancer and AF, LMWH, compared to warfarin, was associated with an increased risk of stroke and all-cause mortality. Furthermore, DOACs was associated with similar risk of stroke, bleeding and death as compared to warfarin.https://doi.org/10.1038/s41598-023-38071-3 |
| spellingShingle | Chatree Chai-Adisaksopha Alexandre H. Watanabe Piyameth Dilokthornsakul Leenhapong Navaravong Daniel M. Witt Nathorn Chaiyakunapruk Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation Scientific Reports |
| title | Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation |
| title_full | Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation |
| title_fullStr | Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation |
| title_full_unstemmed | Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation |
| title_short | Impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation |
| title_sort | impact of type of anticoagulant on clinical outcomes in cancer patients who had atrial fibrillation |
| url | https://doi.org/10.1038/s41598-023-38071-3 |
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