JACC. Advances · 2026
Trends in Oral Anticoagulant Prescribing for Atrial Fibrillation and Active Cancer in UK Primary Care.
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Damba Joseph Junior, Beradid Sarah, Azoulay Laurent, Brophy James M, Renoux Christel
Аннотация
BACKGROUND: Anticoagulation is essential in patients with atrial fibrillation (AF) and cancer, but recent real-world evidence on oral anticoagulant (OAC) use remains limited.
OBJECTIVES: This study aims to describe recent OAC-prescribing trends and identify factors associated with OAC initiation in patients with AF and active cancer in UK primary care.
METHODS: Using the Clinical Practice Research Datalink, we identified patients aged ≥50 years with incident AF (cohort entry) between 2010 and 2023 and active cancer diagnosed in the year before cohort entry. We calculated OAC initiation rates in the year following AF diagnosis among eligible patients (CHA2DS2-VASc ≥2) using Poisson regression, overall and stratified by OAC type, age, sex, and cancer characteristics. Cox proportional hazards regression was used to identify factors associated with OAC initiation.
RESULTS: Among 12,254 eligible patients, 6,940 (56.6%) initiated an OAC. OAC initiation rates rose from 89 per 100 person-years in 2010 to 385 per 100 person-years in 2023 (adjusted rate ratio: 4.32; 95% CI: 3.78-4.93), driven by increased direct oral anticoagulant prescribing. By 2023, apixaban and edoxaban predominated. OAC initiation did not differ by age and sex but was less common in patients with lung cancer (HR: 0.74; 95% CI: 0.67-0.82), metastatic cancer (HR: 0.66; 95% CI: 0.51-0.87), and dementia (HR: 0.75; 95% CI: 0.64-0.88).
CONCLUSIONS: In the last decade, OAC initiation has substantially increased among eligible patients with AF and active cancer, driven by direct oral anticoagulant uptake. However, OAC initiation remained lower among patients with lung cancer, metastatic cancer, or specific comorbidities.
OBJECTIVES: This study aims to describe recent OAC-prescribing trends and identify factors associated with OAC initiation in patients with AF and active cancer in UK primary care.
METHODS: Using the Clinical Practice Research Datalink, we identified patients aged ≥50 years with incident AF (cohort entry) between 2010 and 2023 and active cancer diagnosed in the year before cohort entry. We calculated OAC initiation rates in the year following AF diagnosis among eligible patients (CHA2DS2-VASc ≥2) using Poisson regression, overall and stratified by OAC type, age, sex, and cancer characteristics. Cox proportional hazards regression was used to identify factors associated with OAC initiation.
RESULTS: Among 12,254 eligible patients, 6,940 (56.6%) initiated an OAC. OAC initiation rates rose from 89 per 100 person-years in 2010 to 385 per 100 person-years in 2023 (adjusted rate ratio: 4.32; 95% CI: 3.78-4.93), driven by increased direct oral anticoagulant prescribing. By 2023, apixaban and edoxaban predominated. OAC initiation did not differ by age and sex but was less common in patients with lung cancer (HR: 0.74; 95% CI: 0.67-0.82), metastatic cancer (HR: 0.66; 95% CI: 0.51-0.87), and dementia (HR: 0.75; 95% CI: 0.64-0.88).
CONCLUSIONS: In the last decade, OAC initiation has substantially increased among eligible patients with AF and active cancer, driven by direct oral anticoagulant uptake. However, OAC initiation remained lower among patients with lung cancer, metastatic cancer, or specific comorbidities.