TY - JOUR
T1 - Oral anti-coagulant treatment patterns in atrial fibrillation patients diagnosed with cancer
T2 - A Danish nationwide cohort study
AU - Ording, Anne Gulbech
AU - Søgaard, Mette
AU - Nielsen, Peter Brønnum
AU - Lip, Gregory Y. H.
AU - Larsen, Torben Bjerregaard
AU - Grove, Erik Lerkevang
AU - Skjøth, Flemming
N1 - © 2022 British Society for Haematology and John Wiley & Sons Ltd.
PY - 2022/4
Y1 - 2022/4
N2 - Data on the use of oral anti-coagulants (OAC) for stroke prevention in cancer patients with atrial fibrillation (AF) are sparse. Nationwide cohort study of patients with AF (2012-2018) and an indication for OAC who were diagnosed with cancer at least one year later (N = 12 756). We identified treatment with OAC at cancer diagnosis and the following year and described the incidence of discontinuing or switching between warfarin and direct oral anti-coagulants (DOACs). We also described baseline characteristics associated with OAC non-persistence. One third of the cancer patients received no OAC therapy, whereas 42% received warfarin and 24% received DOAC treatment. Switching incidence between OACs was higher for those receiving warfarin treatment (8.6%) than DOAC treatment (1.7%) within one year. Treatment discontinuation was 61% for warfarin and 26% for DOAC. Females were less likely to discontinue DOAC than males (ratio 0.77, 95% confidence interval: 0.66, 0.90). Increasing cancer stage was associated with discontinuation of DOAC, but not warfarin. OAC for stroke prevention in AF was used by two thirds of patients with newly diagnosed cancer. Switching between OACs and discontinuation was more common for warfarin than DOAC, and females had higher persistence with DOACs.
AB - Data on the use of oral anti-coagulants (OAC) for stroke prevention in cancer patients with atrial fibrillation (AF) are sparse. Nationwide cohort study of patients with AF (2012-2018) and an indication for OAC who were diagnosed with cancer at least one year later (N = 12 756). We identified treatment with OAC at cancer diagnosis and the following year and described the incidence of discontinuing or switching between warfarin and direct oral anti-coagulants (DOACs). We also described baseline characteristics associated with OAC non-persistence. One third of the cancer patients received no OAC therapy, whereas 42% received warfarin and 24% received DOAC treatment. Switching incidence between OACs was higher for those receiving warfarin treatment (8.6%) than DOAC treatment (1.7%) within one year. Treatment discontinuation was 61% for warfarin and 26% for DOAC. Females were less likely to discontinue DOAC than males (ratio 0.77, 95% confidence interval: 0.66, 0.90). Increasing cancer stage was associated with discontinuation of DOAC, but not warfarin. OAC for stroke prevention in AF was used by two thirds of patients with newly diagnosed cancer. Switching between OACs and discontinuation was more common for warfarin than DOAC, and females had higher persistence with DOACs.
KW - Atrial fibrillation
KW - anti-coagulation
KW - factor Xa inhibitors
KW - medication adherence
KW - neoplasms
UR - http://www.scopus.com/inward/record.url?scp=85125767290&partnerID=8YFLogxK
U2 - 10.1111/bjh.18060
DO - 10.1111/bjh.18060
M3 - Journal article
C2 - 35194786
SN - 0007-1048
VL - 197
SP - 223
EP - 231
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 2
ER -