Evaluating efficacy and safety of oral anticoagulation in adult patients with atrial fibrillation and cancer: A systemic review and meta-analysis

• Published in: Thrombosis update Vol. 12; p. 100144
• Main Authors: Ciuffini, L.A., Delluc, A., Wang, T.F., Lodigiani, C., Carrier, M.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.08.2023; Elsevier
• Subjects: Anticoagulants; Atrial Fibrillation; Factor Xa Inhibitors; Neoplasms; Warfarin; Anticoagulants; Warfarin; Factor Xa Inhibitors; Atrial Fibrillation; Neoplasms
• ISSN: 2666-5727; 2666-5727
• DOI: 10.1016/j.tru.2023.100144

Atrial fibrillation (AF) is common among patients with cancer. Patients with cancer and AF require anticoagulant therapy [direct oral anticoagulants (DOAC) or vitamin K antagonist (VKA)] for stroke and systemic embolism (SE) prevention. We sought to assess the rates of stroke/SE and major bleeding in patients with cancer and AF on oral anticoagulant therapy (DOAC or VKA). A systematic search of MEDLINE and EMBASE was conducted. The primary efficacy and safety outcome were stroke/SE and major bleeding (as per the International Society on Thrombosis and Haemostasis definition), respectively. Incidence rates (IR) were pooled using random effects model (event per 100 patient-years). Incidence rate ratios (IRR) were computed using a Poisson regression model with associated 95% confidence intervals (CI) using R software (version 4.0.3). Of the total 2,153 article records that were screened, 22 observational studies from 12 different countries were included in the meta-analysis (n = 94,980 patients). The IR of stroke/SE was 1.81 (95% CI: 0.89 to 3.68) and 3.41 (95% CI: 1.38 to 8.41) per 100 patient-years for patients receiving a DOAC and VKA, respectively (IRR: 0.63 (95%CI: 0.47–0.84)). The IR of major bleeding was 2.59 (95%CI: 1.54 to 4.38) and 3.60 (95% CI: 1.68 to 7.71) per 100 patient-years for patients receiving a DOAC and VKA, respectively (IRR: 0.76 (95% CI: 0.55 to 1.04)). DOACs compared to VKA seem to provide a significant reduction in the risk of stroke/SE and a good risk-benefit ratio profile for safety outcomes in this patient population. •Patients with cancer and atrial fibrillation are at high risk of stroke and bleeding.•Direct oral anticoagulants (DOACs) are associated with a lower risk of stroke compared to vitamin K antagonists.•DOACs seem to provide a good risk-benefit ratio as it may also be associated with lower risk of major bleeding.