Oral anti‐coagulant treatment patterns in atrial fibrillation patients diagnosed with cancer: A Danish nationwide cohort study

Abstract

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.

Anticoagulant Treatment Adherence and Persistence in German Patients with Atrial Fibrillation

“…In addition to dosing frequency, other predictors of impaired adherence include older age and relevant comorbidities, mainly congestive heart failure, dementia, and metastatic cancer. Older age, dementia, and metastatic cancer are consistent with results from previous studies of other OACs [35,36].…”

Effect of Previous INR Control during VKA Therapy on Subsequent DOAC Adherence and Persistence, in Patients Switched from VKA to DOAC

“…3 More recent studies and studies evaluating patients with VTE reported nonpersistent rates varying from 5 to 60% during a follow-up period between 2 months and 4 years. 4,5,8,10,[21][22][23][24][25] The persistence rate of the current study fits in this variation of DOAC nonpersistence. In the previous studies, lower persistence rates were seen in patients with a longer follow-up period, in anticoagulant-naïve patients and in patients treated with dabigatran.…”