, Yusuf Ziya Şener 2
, Kemal Göçer 3
, Hatice Gülgün Fırat 4
, Kardelen Ohtaroğlu Tokdil 5
, Fatih Yıldız 6
, Fadime Bozduman Habip 1
, Eser Açıkgöz 1
, Öztürk Ateş 6
, Demet Menekşe Gerede Uludağ 7
, Elif Eroğlu Büyüköner 8
2Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
3Department of Cardiology, HG Hospital, Kahramanmaraş, Türkiye
4Department of Internal Medicine, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye
5Department of Cardiology, Koç University Hospital, İstanbul, Türkiye
6Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye
7Department of Cardiology, Ankara University, Faculty of Medicine, Ankara, Türkiye
8Department of Cardiology, Acıbadem University, Faculty of Medicine, İstanbul, Türkiye
Abstract
Background: Atrial fibrillation (AF) is frequently encountered in patients with cancer and poses challenges for anticoagulant management. The present study was conducted to compare clinical outcomes associated with direct oral anticoagulants (DOACs) and low-molecular-weight heparin (LMWH) in individuals with active malignancy and nonvalvular AF (NVAF).
Methods: Data from patients with active cancer who received LMWH or DOACs for NVAF were retrospectively screened. Efficacy, safety, and survival outcomes were analyzed.
Results: The study enrolled 222 patients, of whom 25.7% received LMWH and 74.3% received DOACs. Cancer stage, type, and treatment were comparable between groups.
The DOAC group had higher CHA2DS2-VA (3.13 ± 1.21 vs. 2.42 ± 1.33; P < .001) and HAS-BLED scores (2.13 ± 0.83 vs. 1.84 ± 0.79; P = .022). The primary composite endpoint occurred more frequently in the LMWH group (17.5% vs. 12.1%; log-rank P = .036). Myocardial infarction was significantly higher in the LMWH group (8.8% vs. 1.8%; log-rank P = .003), while rates of ischemic stroke (3.5% vs. 6.7%; log-rank P = .927) and venous thromboembolism (5.3% vs. 4.8%; P = .537) were similar. Any bleeding (17.5% vs. 13.3%; log-rank P = .039) and major bleeding (7.0% vs. 1.8%; log-rank P = .010) were more frequent with LMWH, whereas clinically relevant non-major bleeding was comparable (10.5% vs. 11.5%; log-rank P = .359). All-cause mortality was significantly higher in the LMWH group (75.4% vs. 49.1%; log-rank P < .001), and LMWH use independently predicted mortality (hazard ratio = 2.14, P < .001, 95%CI: 1.45-3.17).
Conclusion: Although unmeasured confounders such as drug adherence and selection bias cannot be excluded due to the retrospective design, DOACs appear to be more effective and safer than LMWH in cancer patients with AF.