title: Bleeding risk and major adverse events in patients with cancer on oral anticoagulation therapy.
abstract: BACKGROUND
  The efficacy of oral anticoagulation therapy (OAT) has not been revealed in atrial fibrillation (AF) patients with newly diagnosed cancers. This study evaluated the thromboembolic and bleeding events in AF patients with malignancies according to OAT.
  
  
  RESULTS
  In 2168 consecutive non-valvular AF patients with newly diagnosed malignancies, we analyzed the composite endpoints including major adverse cardiac events (MACEs) and major bleeding. Based on a propensity score matching, two groups with 690 matched pairs were created. Patient baseline characteristics were comparable between the matched groups. During a follow-up period of 3.9 ± 2.8 years, 72 (10%) and 65 (9%) patients had MACEs in the propensity score-matched OAT + and OAT − groups, respectively (p = 0.461). There was no significant difference in the major bleeding (10% vs. 8%, p = 0.300) and composite endpoints (18% vs. 16%, p = 0.181) between OAT + and OAT − patients. During the first year after the cancer diagnosis, 66 (48%) MACEs, 52 (41%) major bleedings, and 116 (49%) composite end points of all events occurred. The optimal international normalized ratio (2.0 to 3.0) level was achieved in only 85 (12%) patients. However, 1 year after cancer diagnosis, OAT + patients with the target therapeutic range of ≥ 60% demonstrated better cumulative survival free of composite end point than OAT − patients (p = 0.026).
  
  
  CONCLUSIONS
  During the first year after the cancer diagnosis, OAT did not improve the composite end point because of poor INR control caused by cancer treatment. However, after 1 year after diagnosis of cancer, optimal anticoagulation significantly reduced the composite end point.
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yong-Joon
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-kyu
authors.initials: JK
authors.lastname: Park
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jong-Yun
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Bundang CHA Medical Center, CHA University, Seongnam, Republic of Korea.
authors.forename: Jung-Hoon
authors.initials: JH
authors.lastname: Sung
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: cby6908@yuhs.ac.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; Cancer; Hemorrhage; Stroke