Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT, USA.
Sci Rep. 2023 Jul 6;13(1):10937. doi: 10.1038/s41598-023-38071-3.
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.
迄今为止，关于同时患有房颤和活动性癌症的患者的最佳抗凝药物选择的证据仍然难以捉摸。本研究旨在描述同时患有房颤和癌症的患者的抗凝模式和临床结局。研究数据来自犹他大学和亨茨曼癌症研究所（HCI）医院。入选标准为患者同时患有房颤和癌症。研究结局为抗凝类型和模式。临床结局为卒中、出血和全因死亡率。1999 年 10 月至 2020 年 12 月，共有 566 例房颤患者同时患有活动性癌症。平均年龄（均数±标准差）为 76.2±10.7 岁，57.6%为男性。与华法林相比，接受直接口服抗凝剂（DOAC）治疗的患者卒中风险相似（校正后的危险比，aHR 0.8，95%置信区间[CI] 0.2-2.7，P=0.67）。相反，与华法林相比，接受低分子肝素（LMWH）治疗的患者卒中风险显著增加（aHR 2.4，95%CI 1.0-5.6，P=0.04）。与华法林相比，DOAC 和 LMWH 导致的总体出血风险相似，aHR 分别为 1.1（95%CI 0.7-1.6，P=0.73）和 1.1（95%CI 0.6-1.7，P=0.83）。与华法林相比，接受 LMWH 但未接受 DOAC 治疗的患者死亡风险增加，aHR 分别为 4.5（95%CI 2.8-7.2，P<0.001）和 1.2（95%CI 0.7-2.2，P=0.47）。在患有活动性癌症和房颤的患者中，与华法林相比，LMWH 增加卒中风险和全因死亡率。此外，与华法林相比，DOAC 导致的卒中、出血和死亡风险相似。
