| アブストラクト | BACKGROUND: Previous evidence suggests a potential protective effect of warfarin against cancer, compared to non-users. However, it may be prone to immortal time bias and residual confounding. OBJECTIVE: We aimed to examine the association between cancer and warfarin, compared with active comparator (direct oral anticoagulants). METHODS: We conducted studies using population-based databases from England and Hong Kong to investigate the association between warfarin and hazard of cancer using a new-user active-comparator cohort design. People with atrial fibrillation aged >/= 18 years who had first received anticoagulant treatment during 01/01/2011-31/12/2019 were involved. RESULTS: No evidence supported the association between warfarin and hazard of overall cancer, compared with direct oral anticoagulants in both settings (England: hazard ratio [HR] = 1.03, 95% confidence interval [CI] 0.94-1.13; Hong Kong: HR = 0.89, 95% CI 0.79-1.01). A lower hazard of female breast (HR = 0.49, 95% CI 0.30-0.79), ovarian (HR = 0.07, 95% CI 0.01-0.58), and pancreatic (HR = 0.46, 95% CI 0.22-0.96) cancers and a higher hazard of kidney cancer (HR = 3.57, 95% CI 1.64-7.76) were found in Hong Kong, comparing warfarin with direct oral anticoagulants, but these were not replicated in England. CONCLUSIONS: This study does not find a protective effect of warfarin against cancer versus direct oral anticoagulants. The risks of site-specific cancers including pancreatic, kidney, and sex-specific cancers between oral anticoagulants shown in the Hong Kong setting only may require further investigation in other independent datasets. |
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| 投稿者 | Wang, Zixuan; Yu, Qiuyan; Matthewman, Julian; Tazare, John; Majano, Sara Benitez; Brown, Jeremy; Cheung, Ka Shing; Chui, Celine S L; Chan, Esther W Y; Bhaskaran, Krishnan; Wong, Ian C K; Douglas, Ian J; Wong, Angel Y S |
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| 組織名 | Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and;Population Health, London School of Hygiene and Tropical Medicine, Keppel St,;London, WC1E 7HT, UK.;Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology;Park, Hong Kong, China.;School of Pharmacy, School of Health Sciences, College of Medicine and Health,;University of Birmingham, Birmingham, UK.;Centre for Safe Medication Practice and Research, Department of Pharmacology and;Pharmacy, The University of Hong Kong, Hong Kong, China.;Department of Medical Statistics, Faculty of Epidemiology and Population Health,;London School of Hygiene and Tropical Medicine, London, UK.;Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, The;University of Hong Kong, Hong Kong, China.;Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen,;China.;School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong,;Hong Kong, China.;School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong;Kong, Hong Kong, China.;Aston School of Pharmacy, Aston University, Birmingham, UK.;London, WC1E 7HT, UK. angel.wong@lshtm.ac.uk.;Park, Hong Kong, China. angel.wong@lshtm.ac.uk.;Pharmacy, The University of Hong Kong, Hong Kong, China. angel.wong@lshtm.ac.uk. |
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