Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Cancer and Atrial Fibrillation: A Systematic Review and Meta-Analysis

source extracted confidence: high 2026-04-09
#anticoagulants #atrial-fibrillation #dabigatran #embolism #factor-xa-inhibitors

Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Cancer and Atrial Fibrillation: A Systematic Review and Meta-Analysis

Deng et al., 2019 | J Am Heart Assoc | Meta Analysis

Citation

Deng Yuqing, Tong Yifan, ... Chen Hui. Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Cancer and Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019-Jul-16;8(14):e012540. doi:10.1161/JAHA.119.012540

Abstract

Background Several studies have investigated the effect of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer, but the results remain controversial. Therefore, we conducted a meta-analysis to compare the efficacy and safety of NOACs versus warfarin in this population. Methods and Results We systematically searched the PubMed and Embase databases until February 16, 2019 for studies comparing the effect of NOACs with warfarin in AF patients with cancer. Risk ratios (RRs) with 95% CIs were extracted and pooled by a random-effects model. Five studies involving 8908 NOACs and 12 440 warfarin users were included. There were no significant associations between cancer status and risks of stroke or systemic embolism, major bleeding, or death in AF patients. Compared with warfarin, NOACs were associated with decreased risks of stroke or systemic embolism (RR, 0.52; 95% CI, 0.28-0.99), venous thromboembolism (RR, 0.37, 95% CI, 0.22-0.63), and intracranial or gastrointestinal bleeding (RR, 0.65; 95% CI, 0.42-0.98) and with borderline significant reductions in ischemic stroke (RR, 0.63; 95% CI, 0.40-1.00) and major bleeding (RR, 0.73; 95% CI, 0.53-1.00). In addition, risks of efficacy and safety outcomes of NOACs versus warfarin were similar between AF patients with and without cancer. Conclusions In patients with AF and cancer, compared with warfarin, NOACs had lower or similar rates of thromboembolic and bleeding events and posed a reduced risk of venous thromboembolism.

Key Findings

Conclusions In patients with AF and cancer, compared with warfarin, NOACs had lower or similar rates of thromboembolic and bleeding events and posed a reduced risk of venous thromboembolism.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population cancer
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Anticoagulants
  • Atrial Fibrillation
  • Dabigatran
  • Embolism
  • Factor Xa Inhibitors
  • Gastrointestinal Hemorrhage
  • Hemorrhage
  • Humans
  • Intracranial Hemorrhages
  • Neoplasms
  • Pyrazoles
  • Pyridines
  • Pyridones
  • Rivaroxaban
  • Stroke
  • Thiazoles
  • Venous Thromboembolism
  • Warfarin

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09