| アブストラクト | BACKGROUND: Anticoagulation of patients with atrial fibrillation (AF) and cancer is challenging because of their high risk for stroke and bleeding. Little is known of the variations of oral anticoagulant (OAC) prescribing in patients with AF with and without cancer. METHODS: Patients with first-time AF during 2009-2019 from the Clinical Practice Research Datalink were included. Cancer diagnosis was defined as a history of breast, prostate, colorectal, lung, or hematological cancer. Competing-risk analysis was used to assess the risk of OAC prescribing in patients with AF and cancer adjusted for clinical and sociodemographic factors. RESULTS: Of 177,065 patients with AF, 11.7% had cancer. Compared to patients without cancer, patients with cancer were less likely to receive OAC: prostate cancer (subhazard ratio [SHR], 0.95; 95% CI, 0.91-0.99), breast cancer (SHR, 0.93; 95% CI, 0.89-0.98), colorectal cancer (SHR, 0.93; 95% CI, 0.88-0.99), hematological cancer (SHR, 0.70; 95% CI, 0.65-0.75), and lung cancer (SHR, 0.44; 95% CI, 0.38-0.50). The cumulative incidence function (CIF) of OAC prescribing was lowest for patients with lung cancer and hematological cancer compared with patients without cancer. The difference between the CIF of OAC prescribing in patients with and without cancer becomes narrower in the most deprived areas. Elderly patients (aged >/=85 years) overall had the lowest CIF of OAC prescribing regardless of cancer status. CONCLUSIONS: In patients with AF, underprescribing of OAC is independently associated with certain cancer types. Patients with hematological and lung cancer are the least likely to receive anticoagulation therapy compared with patients without cancer. Underprescribing of OAC in cancer is linked to old age. Further studies of patients with AF and cancer are warranted to assess the net clinical benefit of anticoagulation in certain cancer types. |
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| 投稿者 | Ajabnoor, Alyaa M; Parisi, Rosa; Zghebi, Salwa S; Ashcroft, Darren M; Faivre-Finn, Corinne; Morris, Charlotte; Mamas, Mamas A; Kontopantelis, Evangelos |
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| 組織名 | Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University,;Jeddah, Saudi Arabia.;Division of Informatics, Imaging and Data Sciences, School of Health Sciences,;Faculty of Biology, Medicine and Health, Manchester Academic Health Science;Centre, University of Manchester, Manchester, UK.;Division of Population Health, Health Services Research and Primary Care, School;of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic;Health Science Centre, University of Manchester, Manchester, UK.;Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and;Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health,;University of Manchester, Manchester, UK.;National Institute for Health and Care Research (NIHR), Greater Manchester;Patient Safety Translational Research Centre (PSTRC), University of Manchester,;Manchester, UK.;Christie National Health Service Foundation Trust and University of Manchester,;Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for;Primary Care and Health Sciences, Keele University, Keele, UK. |
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