Risks and outcomes of gastrointestinal malignancies in anticoagulated atrial fibrillation patients experiencing gastrointestinal bleeding: A nationwide cohort study


Chang, Ting-Yung, Chan, Yi-Hsin, Chiang, Chern-En, Lin, Yenn-Jiang, Chang, Shih-Lin, Lo, Li-Wei, Hu, Yu-Feng, Tuan, Ta-Chuan, Liao, Jo-Nan, Chung, Fa-Po et al (show 4 more authors) (2020) Risks and outcomes of gastrointestinal malignancies in anticoagulated atrial fibrillation patients experiencing gastrointestinal bleeding: A nationwide cohort study. Heart Rhythm, 17 (10). pp. 1745-1751.

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Abstract

<h4>Background</h4>Oral anticoagulants (OACs) may serve as a "screening test" for gastrointestinal (GI) tract malignancies through the clinical presentation of bleeding.<h4>Objective</h4>The purpose of this study was to investigate the 1-year incidence and predictors of GI cancer after GI bleeding among atrial fibrillation (AF) patients treated with warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). The risks of mortality after GI cancers between patients receiving warfarin and those receiving NOACs were compared.<h4>Methods</h4>A total of 10,845 anticoagulated AF patients hospitalized due to GI bleeding without a previous history of GI cancer were identified from the Taiwan National Health Insurance Research Database. Patients were followed-up for incident GI cancers for up to 1 year.<h4>Results</h4>Within 1 year after GI bleeding, 290 patients (2.67%) were diagnosed with GI tract cancer. More patients treated with NOACs were diagnosed with GI cancer than those treated with warfarin (3.87% vs 2.44%; P <.001; odds ratio [OR] 1.606; P <.001). Age (OR 1.025 per 1-year increment) and male sex (OR 1.356) were associated with the diagnosis of GI cancer. Among patients diagnosed with GI cancer, 45.2% died within 1 year. The risk of mortality was lower in patients treated with NOACs than in those treated with warfarin (23.5% vs 51.8%; adjusted hazard ratio 0.441; P <.001).<h4>Conclusion</h4>Incident GI cancers were diagnosed in 1 of 37 AF patients at 1 year after OAC-related GI bleeding and were more common among patients treated with NOACs (1/26) compared to warfarin (1/41). Detailed examinations for occult GI cancers are necessary, especially among elderly males.

Item Type: Article
Uncontrolled Keywords: Atrial fibrillation, Cancer, Gastrointestinal bleeding, Non-vitamin K antagonist oral anticoagulant, Warfarin
Depositing User: Symplectic Admin
Date Deposited: 10 Nov 2020 08:22
Last Modified: 18 Jan 2023 23:22
DOI: 10.1016/j.hrthm.2020.05.026
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3106454
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