Effect of Cancer on Clinical Outcomes in Elderly Patients With Non-Valvular Atrial Fibrillation　― Substudy of the ANAFIE Registry

• Published in: Circulation Journal Vol. 86; no. 2; pp. 202 - 210
• Main Authors: Ikeda, Takanori, Yamashita, Takeshi, Akao, Masaharu, Atarashi, Hirotsugu, Koretsune, Yukihiro, Okumura, Ken, Shimizu, Wataru, Tsutsui, Hiroyuki, Toyoda, Kazunori, Hirayama, Atsushi, Yasaka, Masahiro, Yamaguchi, Takenori, Teramukai, Satoshi, Kimura, Tetsuya, Kaburagi, Jumpei, Takita, Atsushi, Inoue, Hiroshi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.01.2022
• Subjects: Administration, Oral; Aged; Anticoagulants - adverse effects; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Bleeding; Cancer; Elderly; Embolism - chemically induced; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Neoplasms - complications; Neoplasms - drug therapy; Neoplasms - epidemiology; Prospective Studies; Registries; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Thromboembolism; Treatment Outcome; Warfarin - adverse effects; Thromboembolism; Elderly; Atrial fibrillation; Bleeding; Cancer
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-21-0631

Background:Data on outcomes for patients with atrial fibrillation (AF) and active cancer are scarce. The effect of active cancer on thrombosis and bleeding risks in elderly (≥75 years) patients with non-valvular AF (NVAF) enrolled in the All Nippon AF In the Elderly (ANAFIE) Registry were prospectively analyzed.Methods and Results:In this subanalysis of the ANAFIE Registry, a prospective, multicenter, observational study conducted in Japan, we compared the incidence rates of clinical outcomes between active cancer and non-cancer groups. Relationships between primary outcomes and anticoagulation status were evaluated. Of the 32,725 patients enrolled in the Registry, 3,569 had active cancer at baseline; 92.0% of active cancer patients received anticoagulants (23.7%, warfarin; 68.2%, direct oral anticoagulants [DOACs]). Two-year probabilities of stroke/systemic embolic events (SEE) were similar in the cancer (3.33%) and non-cancer (3.16%) groups. Patients with cancer had greater incidences of major bleeding (2.86% vs. 2.04%), all-cause death (10.95% vs. 6.77%), and net clinical outcomes (14.63% vs. 10.00%) than those without cancer. In patients without cancer, DOACs were associated with a decreased risk of stroke/SEE, major bleeding, all-cause death, and net clinical outcome compared with warfarin. No between-treatment differences were observed in patients with active cancer.Conclusions:Active cancer had no effect on stroke/SEE incidence in elderly NVAF patients, but those with cancer had higher incidences of major bleeding events and all-cause death than those without cancer.