Wu Victor Chien-Chia, Wang Chun-Li, Huang Yu-Tung, Lan Wen-Ching, Wu Michael, Kuo Chang-Fu, Chen Shao-Wei, Chu Pao-Hsien, Wen Ming-Shien, Kuo Chi-Ching, Chang Shang-Hung
Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
J Cancer. 2020 Jan 1;11(1):92-99. doi: 10.7150/jca.36468. eCollection 2020.
Cancer patients with atrial fibrillation (AF) were excluded in the major clinical trials. We therefore investigated the efficacy and safety of novel oral anticoagulant (NOAC) versus warfarin in these patients. Data were retrieved from Taiwan National Health Insurance Research Database during 2010-2017 for patients with AF, excluding those without cancer or >1 cancer, not using anticoagulant, switching of agents, patients age <18, and cancer and AF diagnosed >1 month apart. Primary outcomes are ischemic stroke (IS)/systemic embolism (SE), GI bleeding, major bleeding, intracranial hemorrhage (ICH), acute myocardial infarction (AMI), and death from any cause at 6 months and 1 year. After exclusion criteria and propensity score matching, there were 336 patients in each group. Patients on NOAC had significantly reduced IS/SE (HR=0.45, 95% CI=0.25-0.82), major bleeding (HR=0.21, 95% CI=0.05-0.96), and no ICH at 6 months. In addition, IS/SE (HR=0.42, 95% CI=0.24-0.74), major bleeding (HR=0.26, 95% CI=0.09-0.76), and no ICH at 1 year compared to patients on warfarin. There was no difference on GI bleeding, AMI, and death from any cause at 6 months and at 1 year. In cancer patients with AF, NOAC were associated with significant reduced IS/SE, major bleeding, and ICH compared to warfarin.
心房颤动（AF）癌症患者被排除在主要临床试验之外。因此，我们研究了新型口服抗凝剂（NOAC）与华法林在这些患者中的疗效和安全性。数据取自2010年至2017年台湾国民健康保险研究数据库中AF患者，排除无癌症或患有多种癌症、未使用抗凝剂、药物转换、年龄<18岁以及癌症和AF诊断间隔>1个月的患者。主要结局指标为6个月和1年时的缺血性卒中（IS）/全身性栓塞（SE）、胃肠道出血、大出血、颅内出血（ICH）、急性心肌梗死（AMI）以及任何原因导致的死亡。经过排除标准和倾向评分匹配后，每组有336例患者。使用NOAC的患者在6个月时IS/SE显著降低（HR=0.45，95%CI=0.25-0.82）、大出血（HR=0.21，95%CI=0.05-0.96），且无ICH。此外，与使用华法林的患者相比，1年时IS/SE（HR=0.42，95%CI=0.24-0.74）、大出血（HR=0.26，95%CI=0.09-0.76），且无ICH。6个月和1年时在胃肠道出血、AMI以及任何原因导致的死亡方面无差异。在AF癌症患者中，与华法林相比，NOAC与IS/SE、大出血和ICH显著降低相关。
