OC 74.3 - Anticoagulant use and prognosis in patients with atrial fibrillation and cancer: a nationwide population-based study

Wednesday, June 28, 2023

10:45 – 11:00 ET

Room: 511

Session Available As: On-Demand

Presenting Author(s)

Qingui Chen, MD (he/him/his)

Phd student
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

Nienke van Rein, PharmD PhD

Post doc, PhD PharmD
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
Tv

Tom van Der Hulle

Senior medical specialist
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
ST

Serge Trines

Senior medical specialist
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
HV

Henri Versteeg

Professor
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Erik Klok, MD, PhD, FESC

Leiden University Medical Center
SC

Suzanne C. Cannegieter, MD PhD

Professor
Department of Clinical Epidemiology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Background: Anticoagulant use and prognosis of patients with both atrial fibrillation (AF) and cancer have rarely been investigated with recent and large-scale data.

Aims: To describe the anticoagulation patterns and prognosis of this specific patient population in The Netherlands (2015-2019).

Methods: Using nationwide registries from Statistics Netherlands, all Dutch inhabitants with incident AF and prior cancer were identified as the Cancer-AF cohort (n=29,782), and all individuals with incident cancer and prior AF were identified as the AF-cancer cohort (n=25,024). Within each cohort, anticoagulant use in the six months before and after having both conditions was examined using data on outpatient medication prescriptions. After stratification by calendar years of the incident AF or cancer diagnosis, anticoagulant use and prognosis (i.e., ischemic stroke, major bleeding, venous thromboembolism [VTE], and all-cause mortality) within the 1-year follow-up after having both conditions were compared between years.

Results: After having both AF and cancer, the (6-month) proportion of receiving ≥1 anticoagulant prescription increased from 43.7% to 68.5% in the Cancer-AF cohort, while it decreased from 82.1% to 70.5% in the AF-cancer cohort (Figure 1). From 2015 to 2019, the proportion of days covered by anticoagulants within the one year after having both conditions slightly increased from ≈60% to ≈70% in both cohorts, driven by an increase in use of direct oral anticoagulants (DOACs), while use of vitamin K antagonists and heparin group decreased. Meanwhile, the incidence of adverse events and survival remained broadly stable over time, although the incidence of VTE in the AF-cancer cohort seemed to decrease (Figure 2). The absolute 1-year risk of major bleeding remained high (>3%).

Conclusion(s): Patients with both AF and cancer in The Netherlands were increasingly anticoagulated in the DOAC era, without a measurable change in prognosis.

Learning Objectives:

describe potential changes in anticoagulant use before and after having both atrial fibrillation and cancer
describe the time trends in prescription patterns of anticoagulants among patients with both atrial fibrillation and cancer
describe the time trends in occurrence of adverse events related to anticoagulant use among patients with both atrial fibrillation and cancer