Ording, Anne Gulbech, Sogaard, Mette, Skjoth, Flemming, Grove, Erik Lerkevang, Lip, Gregory YH 
ORCID: 0000-0002-7566-1626, Larsen, Torben Bjerregaard and Nielsen, Peter Bronnum
(2021)
Bleeding complications in patients with gastrointestinal cancer and atrial fibrillation treated with oral anticoagulants.
CANCER MEDICINE, 10 (13).
pp. 4405-4414.
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Abstract
<h4>Background</h4>Direct oral anticoagulants (DOACs) may increase the risk of gastrointestinal (GI) bleeding in patients with atrial fibrillation (AF) and GI cancer compared with vitamin K antagonists (VKA).<h4>Methods</h4>We conducted a Danish nationwide cohort study comparing the bleeding risk associated with DOAC versus VKA in patients with AF and GI cancer. We calculated crude bleeding rates per 100 person-years (PYs) for GI and major bleeding. We then compared rates of bleeding at 1 year after initial oral anticoagulation filled prescription by treatment regimen using inverse probability of treatment weighting and Cox regression.<h4>Results</h4>The unweighted study population included 1476 AF patients with GI cancer (41.6% women, median age 78 years) initiating a DOAC and 652 initiating a VKA. One-year risk of GI bleeding was 5.0% in the DOAC group and 4.7% in the VKA group with a corresponding weighted hazard ratio (HR) of 0.95 (95% confidence interval [CI]: 0.63, 1.45). For patients with active cancer, weighted GI bleeding rates were slightly higher in both the VKA and DOAC group, and the weighted HR was 1.00 (95% CI: 0.53, 1.88). The HR was 1.12 (95% CI: 0.71, 1.76) for all bleedings. Hazard ratios for GI bleeding were 0.61 (95% CI: 0.25, 1.52) for patients with upper GI cancer, and 0.92 (95% CI: 0.58, 1.46) in patients with colorectal cancer.<h4>Conclusion</h4>Evidence from this nationwide cohort study suggests a comparable 1-year risk of bleeding associated with DOAC compared with VKA among patients with AF and GI cancer.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | atrial fibrillation, gastrointestinal neoplasms, hemorrhage, anticoagulants, factor Xa inhibitors |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 26 Sep 2023 14:18 |
| Last Modified: | 26 Sep 2023 14:18 |
| DOI: | 10.1002/cam4.4012 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173079 |
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