Relationships, Current Issues, Safety and Efficacy of Oral Anticoagulation in Cancer Patients with Atrial Fibrillation.
Antonio Gabriele FranchinaMatteo RocchettiElena SalaAlessandra LaricchiaAlessandro MinardiAndrea SpangaroMarco GuazziStefano LucreziottiAlberto CeredaPublished in: Journal of clinical medicine (2023)
A relationship between malignancy and impaired hemostasis has been proven, and balancing clotting and bleeding risks can be challenging. Half of cancer patients with atrial fibrillation (AF) do not receive any oral anticoagulation (OAC). Using PubMed on the relationship between cancer and AF and their association with hemostasis, targeting studies comparing vitamin K antagonists (VKAs) and direct OAC (DOAC) strategies in AF cancer patients, three RCTs (>3000 patients) and eight observational studies (>250,000 patients) comparing different OACs were retrieved. The VKA prescribed was always warfarin. Dabigatran was the only DOAC not analyzed in the RCTs but the most used in non-randomized studies, whereas edoxaban-treated patients were the majority in the RCTs. Overall, the DOAC patients showed similar or lower rates of efficacy (thromboembolic) and safety (bleeding) outcomes compared to the VKA patients. DOACs are subject to fewer interactions with antineoplastic agents. DOACs may be preferable to VKAs as a thromboembolic prophylaxis in cancer patients with non-valvular AF.
Keyphrases
- atrial fibrillation
- end stage renal disease
- newly diagnosed
- ejection fraction
- chronic kidney disease
- prognostic factors
- peritoneal dialysis
- direct oral anticoagulants
- type diabetes
- venous thromboembolism
- adipose tissue
- clinical trial
- open label
- risk assessment
- skeletal muscle
- patient reported outcomes
- drug delivery
- insulin resistance
- phase iii
- case control