Abstract Number: OC 65.4
Meeting: ISTH 2021 Congress
Background: Evidence on optimal anticoagulant options in patients with AF who concurrently have active cancer remains elusive.
Aims: To describe anticoagulation treatment patterns and to assess the clinical outcomes associated with different anticoagulant strategy in AF patients who concurrently had active cancer.
Methods: Data was obtained from the University of Utah and Huntsman Cancer Institute (HCI) Hospitals. We included patients aged 18 years old or older who had a diagnosis of cancer and atrial fibrillation and who used of at least one anticoagulation therapy (warfarin, direct oral anticoagulant [DOAC] or low-molecular-weight heparin [LMWH] or unfractionated heparin [UFH]). Primary outcome was the treatment pattern for anticoagulation therapy, occurrence of thrombosis and bleeding events up to 1 year after cancer diagnosis.
Results: There were 566 patients included in the analysis. Mean age (standard deviation) was 76.2 years (10.8). Males were 57.6%. Of these, 309 (54.6%) patients had AF prior to cancer diagnosis. The rest of patients (257, 45.4%) had AF after cancer diagnosis. Majority of patients who had AF prior to cancer diagnosis continued to use the same anticoagulant (76.2%, 81.8% and 77.9% for warfarin, DOAC and LMWH/UFH users before cancer diagnosis). Table 1 demonstrates thrombotic and bleeding events after cancer diagnosis. Patients who used LMWH/UFH were associated with higher risk any arterial thrombosis (odds ratio 3.85, 95%CI 1.44-3.11), compared to warfarin group. Patients who used DOACs were associated with lower risk of venous thrombosis as compared to warfarin group (OR 0.47, 95%CI 0.27-0.83). Comparing to warfarin, patients who used LMWH/UFH were associated with higher any bleeding events (OR 2.49, 95%CI 1.60-3.88).
Conclusions: Our study demonstrates a variety of anticoagulation prescription in AF patients who had active cancer. We observed differences of thrombotic and bleeding outcomes that might be attributed from anticoagulant strategy or patients’ predisposition. Prospective trials in AF patients with cancer are urgently needed.
To cite this abstract in AMA style:Chai-Adisaksopha C, Watanabe A, Dilokthornsakul P, Navaravong L, Chaiyakunapruk N. Prescription Patterns and Impact of Anticoagulant Therapy in Patients with Atrial Fibrillation who Had Active Cancer [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/prescription-patterns-and-impact-of-anticoagulant-therapy-in-patients-with-atrial-fibrillation-who-had-active-cancer/. Accessed October 20, 2021.
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