Use of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients with Malignancy: Clinical Practice Experience in a Single Institution and Literature Review

Vincenzo Russo; Anna Rago; Andrea Antonio Papa; Federica Di Meo; Emilio Attena; Paolo Golino; Antonio D'Onofrio; Gerardo Nigro

doi:10.1055/s-0037-1607436

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2018; 44(04): 370-376
DOI: 10.1055/s-0037-1607436

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Use of Non–Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients with Malignancy: Clinical Practice Experience in a Single Institution and Literature Review

Vincenzo Russo

¹Department of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy

,

Anna Rago

¹Department of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy

,

Andrea Antonio Papa

¹Department of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy

,

Federica Di Meo

¹Department of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy

,

Emilio Attena

²Department of Cardiology, Fatebenefratelli Hospital, Naples, Italy

,

Paolo Golino

¹Department of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy

,

Antonio D'Onofrio

³Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy

,

Gerardo Nigro

¹Department of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy

› Author Affiliations

Abstract

This observational study aimed to investigate the efficacy and safety of non–vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with malignancy. A total of 76 patients (mean age: 73.2 ± 8.9; 28 females) with AF and malignancy treated with NOAC were included in the analysis. The mean CHA₂DS₂-VASc and HAS-BLED scores were 3.2 ± 1.2 and 2.2 ± 0.9, respectively. The study population was taking dabigatran 150 mg (25%) twice daily (BID), apixaban 5 mg BID (25%), dabigatran 110 mg BID (24%), rivaroxaban 20 mg (18%) once a day (OD), rivaroxaban 15 mg OD (5%), or apixaban 2.5 mg OD (3%). NOAC therapy began, on average, 248 ± 238 days before malignancy diagnosis for an average duration of 1,000 ± 289 days. Stroke, transient ischemic attack, major and minor bleeding events, other adverse effects, and major cardiovascular complications during the follow-up period were collected. In our study population, no patients experienced thromboembolic events during therapy with any NOAC. We recorded a low global incidence of major bleeding (3.9%) with a mean annual incidence of 1.4%. No hemorrhagic stroke or subarachnoid hemorrhage was observed. Only nine patients (11.8%) experienced minor bleeding. According to our data, anticoagulation therapy with NOACs seems to be an effective and safe treatment strategy for nonvalvular AF patients with malignancy.

Keywords

atrial fibrillation - cancer - NOAC - clinical practice - dabigatran - apixaban - rivaroxaban - malignancy - stroke - bleeding - safety - efficacy

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References

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