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Superior safety of direct oral anticoagulants compared to Warfarin in patients with atrial fibrillation and underlying cancer: a national veterans affairs database study

查看全文 作　　者：Abhishek C [1]Sawant;Arnav [2]Kumar;Wilmon [3]Mccray;Sheldon [3]Tetewsky;Linda [1]Parone;Srilekha [1]Sridhara;Meghana Prakash Hiriyur [1]Prakash;Gary [4]Tse;Tong [5]LIU;Nidhi [1]Kanwar;Aishwarya [3]Bhardwaj;Sahoor [3]Khan;Christopher [3]Manion;Ankush [3]Lahoti;Ashish [1]Pershad;Peter [3]Elkin;John [3]Corbelli 高影响力作者 机构地区：[1]Banner University Medical Center, Phoenix, Arizona, USA;[2]Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Cardiovascular Medicine, Atlanta, GA, USA;[3]Western New York Healthcare System, Buffalo VA Medical Center, Buffalo, NY, USA;[4]Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China;[5]Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China高影响力机构 出　　处：《Journal of Geriatric Cardiology》索引2019年第16卷第9期,共4页高影响力期刊 基　　金：funded by the Thomas F. Frawley, MD, Research Fellowship Fund awarded to Dr. Sawant 摘　　要：Background Studies evaluating safety of warfarin and direct oral anticoagulants(DOACs) for prevention of stroke in patients with atrial fibrillation(AF) are lacking. Methods & Results All patients(n = 196,521) receiving care at veteran’s affairs with active cancer and AF from 2010–2015 were included. One-year mortality was significantly higher in unadjusted analysis with warfarin(44.9%) compared to dabigatran(25%, P < 0.001), rivaroxaban(24.4%, P < 0.001) and apixaban(30%, P < 0.001) and after adjusting for age, sex and type of cancer mortality(OR = 2.66, 95% CI: 2.52–2.82, P < 0.001). Risk of ischemic stroke(13.5% vs. 11.1%, 12.0%, 14.0%) was similar, however risk of hemorrhagic stroke was significantly higher among patients receiving warfarin(1.2%) compared to patients receiving dabigatran(0.5%), rivaroxaban(0.7%) and apixaban(0.8%) respectively, P = 0.04. Conclusions We demonstrated the superior safety profile of DOACs compared to warfarin among patients with underlying cancer and AF. Warfarin was associated with higher mortality, similar ischemic stroke risk but higher risk of hemorrhagic stroke. 关 键 词：ATRIAL FIBRILLATION CANCER Oral ANTICOAGULATION
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