Effect of non-Vitamin K antagonist oral anticoagulants in atrial fibrillation patients with newly diagnosed cancer

Background and Objectives: There are limited data on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fbrillation (AF) patients with cancer. We aimed to assess the efcacy and safety of NOACs in AF patients with cancer in this study. Methods: In 2,568 consecutive non-valvular AF patients with newly diagnosed cancer, we analyzed ischemic stroke/systemic embolism (SE), major bleeding, and all-cause death. Based on propensity score matching, 388 matched pairs were included in the NOAC and warfarin groups. Results: Patient baseline characteristics were comparable between the matched groups. During median follow-up of 1.8 years, the NOAC group had signifcantly lower incidences of ischemic stroke/SE (p<0.001), major bleeding (p<0.001), and all-cause death (p<0.001) than the warfarin group. Moreover, the incidence of major bleeding was signifcantly lower in the NOAC group than in the warfarin group with optimal international normalized ratio control (p=0.03). Especially, within 1 year afer cancer diagnosis, the incidences of all clinical events were signifcantly lower in the NOAC group than in the warfarin group. Conclusions: In AF patients with newly diagnosed cancer, NOACs showed lower incidences of ischemic stroke/SE, major bleeding, and all-cause death than warfarin, especially within 1 year afer cancer diagnosis.