A Spin-Off in Non Valvular Atrial Fibrilation (NVAF) and Cancer : Doacs As a Safe and Effective Alternative to the Convencional Avks

Introduction:

The anticoagulation is common in patients with cancer such as treatment or prevention of venous thromboembolic events (VTE) or atrial fibrillation (AF). The evidence for the effectiveness and safety of the direct oral anticoagulants (DOACs) in those clinical setting are sparse, even more in AF patients.

Aim: to analyze the effectiveness and safety of the DOACs, and other clinical aspects of patients with active cancer in the treatment of atrial fibrillation in daily clinical practice.

Methods:

Between Nov 2011 and May 2016 we had included consecutively adult patients with AF who initiated DOACs treatment. We selected patients with active cancer. Follow-up (FU) was an outpatient visits each 3 months and thereafter effectiveness, safety and other related to treatment data were collected. All bleeds were classified using the ISTH criteria.

Results:

900 patients were included in our register where 6.1% (n=55) had an active cancer. Median age was 78 years (range 57-91) and 45.5% were women and 55.5% men. The median of creatinina clearance 59 ml/min (range 30-101). The distribution for treatment groups was: dabigatran 16.4% (n=9) with 24 months or days FU, rivaroxaban 50% (n=28) with 8 months and apixaban 32.7%(n=18) with 4 months. Ischemic strokes occurred in 16.4% of the patients with cancer (n=9).During FU, 10 patients presented bleeding complications (7.3 % minor,7.3% non-major clinically relevant and 3.6 % major bleeding according to ISTH definition).The mucocutaneous bleeding was the most common site of bleeding (30% of total bleeding) in the 5.5% drugs. In the clinical FU we observed 2 deaths, related to progression of the underlying disease. The DOACs discontinuation occurred in 16.4% (n=9) due to presence of bleeding events, hematological toxicity in chemotherapy; and worsening functio renal. The DOAC treatment was maintained concomitant with antineoplastic therapy in 83.6% (n=46) without associated complications.

Conclusion:

DOACs in active cancer-patients patients showed a good effectiveness and safety and they can be a great option in the treatment of NVAF, especially in those cases with unestable INR ranges.. There is an urgent need for more clinical studies in cancer patients treated with DOACs that can be candidates to these, in terms to offer them a better therapeutic options.