Deitelzweig Steven, Keshishian Allison V, Zhang Yan, Kang Amiee, Dhamane Amol D, Luo Xuemei, Klem Christian, Ferri Mauricio, Jiang Jenny, Yuce Huseyin, Lip Gregory Y H
Ochsner Clinic Foundation, Department of Hospital Medicine, New Orleans, Louisiana, USA.
University of Queensland School of Medicine-Ochsner Clinical School, New Orleans, Louisiana, USA.
JACC CardioOncol. 2021 Sep 21;3(3):411-424. doi: 10.1016/j.jaccao.2021.06.004. eCollection 2021 Sep.
Patients with cancer are more likely to develop nonvalvular atrial fibrillation (NVAF). Currently there are no definitive clinical trials or treatment guidelines for NVAF patients with concurrent cancer.
This subgroup analysis of the ARISTOPHANES study compared the risk of stroke/systemic embolism (stroke/SE) and major bleeding (MB) among NVAF patients with active cancer who were prescribed non-vitamin K antagonist oral anticoagulants (NOACs) or warfarin.
A retrospective observational study was conducted in NVAF patients with active cancer who newly initiated apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, through September 30, 2015, with the use of Medicare and 4 U.S. commercial claims databases. Cox models were used to estimate the risk of stroke/SE and MB in the pooled propensity score-matched cohorts.
A total of 40,271 patients were included, with main cancer types of prostate (29%), female breast (17%), genitourinary (14%), and lung (13%). Compared with warfarin, apixaban was associated with a lower risk of stroke/SE (hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.45-0.78) and MB (HR: 0.58; 95% CI: 0.50-0.68); dabigatran and rivaroxaban had similar risks of stroke/SE (dabigatran: HR: 0.88 [95% CI: 0.54-1.41]; rivaroxaban: HR: 0.82 [95% CI: 0.62-1.08]) and MB (dabigatran: HR: 0.76 [95% CI: 0.57-1.01]; rivaroxaban: HR: 0.95 [95% CI: 0.85-1.06]). Risks of stroke/SE and MB varied among NOAC-NOAC comparisons, while consistent treatment effects were seen for all treatment comparisons across key cancer types.
Among this cohort of NVAF patients with active cancer, the risk of stroke/SE and MB varied among oral anticoagulants and were consistent across cancer types.
癌症患者更易发生非瓣膜性心房颤动（NVAF）。目前，对于合并癌症的NVAF患者，尚无确切的临床试验或治疗指南。
ARISTOPHANES研究的这一亚组分析比较了接受非维生素K拮抗剂口服抗凝剂（NOACs）或华法林治疗的活动性癌症NVAF患者发生卒中/全身性栓塞（卒中/SE）和大出血（MB）的风险。
对2013年1月1日至2015年9月30日期间新开始使用阿哌沙班、达比加群、利伐沙班或华法林的活动性癌症NVAF患者进行了一项回顾性观察研究，使用了医疗保险和4个美国商业索赔数据库。Cox模型用于估计汇总的倾向评分匹配队列中卒中/SE和MB的风险。
共纳入40271例患者，主要癌症类型为前列腺癌（29%）、女性乳腺癌（17%）、泌尿生殖系统癌（14%）和肺癌（13%）。与华法林相比，阿哌沙班发生卒中/SE的风险较低（风险比[HR]：0.59；95%置信区间[CI]：0.45 - 0.78），发生MB的风险也较低（HR：0.58；95% CI：0.50 - 0.68）；达比加群和利伐沙班发生卒中/SE的风险相似（达比加群：HR：0.88 [95% CI：0.54 - 1.41]；利伐沙班：HR：0.82 [95% CI：0.62 - 1.08]），发生MB的风险也相似（达比加群：HR：0.76 [95% CI：0.57 - 1.01]；利伐沙班：HR：0.95 [95% CI：0.85 - 1.06]）。在NOAC - NOAC比较中，卒中/SE和MB的风险各不相同，而在所有关键癌症类型的治疗比较中均观察到一致的治疗效果。
在这一队列的活动性癌症NVAF患者中，口服抗凝剂发生卒中/SE和MB的风险各不相同，且在各癌症类型中一致。
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