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Bleeding risk and major adverse events in patients with cancer on oral anticoagulation therapy.

Authors
 Yong-Joon Lee  ;  Jin-kyu Park  ;  Jae-Sun Uhm  ;  Jong-Yun Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Jung-Hoon Sung  ;  Boyoung Joung 
Citation
 INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol.203 : 372-378, 2016 
Journal Title
 INTERNATIONAL JOURNAL OF CARDIOLOGY 
ISSN
 0167-5273 
Issue Date
2016
MeSH
Administration, Oral ; Aged ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects* ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy* ; Female ; Follow-Up Studies ; Hemorrhage/chemically induced* ; Hemorrhage/epidemiology ; Humans ; Incidence ; Male ; Neoplasms/complications ; Neoplasms/drug therapy* ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment/methods* ; Risk Factors ; Stroke/etiology ; Stroke/prevention & control* ; Survival Rate/trends ; Time Factors
Keywords
Anticoagulation ; Atrial fibrillation ; Cancer ; Hemorrhage ; Stroke
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. METHODS AND 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). CONCLUSION: 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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0167527315307300
DOI
10.1016/j.ijcard.2015.10.166
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146245
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