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July 9, 2026CancerOpen Access

DOACs linked to ~63% lower mortality vs VKAs in AF patients with cancer.

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Why the study?

Do DOACs reduce mortality and cardiovascular events compared to VKAs in atrial fibrillation patients with cancer?

Population

1605 atrial fibrillation patients with cancer from the nationwide Italian Survey on Anticoagulated Patients…

Comparison

Direct oral anticoagulants (DOACs) vs Vitamin K antagonists, stratified by…

Design

Cohort

Follow-up

mean 729.8 days

Key result

Direct oral anticoagulants were associated with lower all-cause mortality (HR 0.37, p<0.001) and cardiovascular events (sHR 0.58, p=0.005) compared to vitamin K antagonists in AF patients with cancer.

Authors

DMDanilo MenichelliVCVito Maria CormaciGGGianluca Gazzaniga

Discussion

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Overview

May favor DOACs in cancer-associated AF; hypothesis-generating and requires RCT confirmation before practice change.

Key Points

  • This research examines the effectiveness of direct oral anticoagulants (DOACs) compared to warfarin in atrial fibrillation patients with cancer, focusing on mortality and cardiovascular events.
  • Included AF patients with cancer from the Italian Survey on Anticoagulated Patients Register.
  • Propensity score matching was performed to analyze outcomes.
  • Follow-up duration averaged 729.8 days, assessing mortality, CVEs, and bleeding risk.
  • DOACs were associated with 63% lower all-cause mortality (HR 0.37, p < .001) and 42% lower CVEs risk (sHR 0.58, p = .005) compared to VKAs.
  • The lowest NNT for mortality was 28.2 at 24 months, with similar bleeding risk compared to VKAs.
  • DOACs reduced mortality in patients with TiTR <70% and showed increased risk of bleeding in those with TiTR ≥70%.

Study Design

Type

Cohort (n=1,605)

Multicenter

Yes

Structured PICO

Do DOACs reduce mortality and cardiovascular events compared to VKAs in atrial fibrillation patients with cancer?

P
Population
1,605 atrial fibrillation patients with cancer (median age 78, 44.7% women) on oral anticoagulants, followed for a mean of 729.8 days.
E
Exposure
Direct oral anticoagulants (DOACs)
C
Comparator
Vitamin K antagonists (VKAs), stratified by time-in-therapeutic-range (TiTR) <70% or ≥70%
O
Outcome
All-cause mortality, cardiovascular events (CVEs), and bleeding riskhard clinical

Main Result

Hazard Ratio: 0.37

Number Needed to Treat: 28.2

p-value: p=<0.001

DOACs may reduce mortality and cardiovascular events in AF patients with cancer compared to VKAs, but should be used cautiously in high-bleeding risk patients when VKA control is excellent.

Cite This Study

Menichelli et al. (2026) conducted a cohort in Atrial fibrillation with cancer (n=1,605). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on All-cause mortality (HR 0.37, p=<0.001). Direct oral anticoagulants were associated with lower all-cause mortality (HR 0.37, p<0.001) and cardiovascular events (sHR 0.58, p=0.005) compared to vitamin K antagonists in AF patients with cancer.

synapsesocial.com/papers/6a4f3b382b81a944af575446https://doi.org/10.1002/cncr.70501
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