Risks and outcomes of gastrointestinal malignancies in anticoagulated atrial fibrillation patients experiencing gastrointestinal bleeding: A nationwide cohort study

Ting Yung Chang, Yi Hsin Chan, Chern En Chiang, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Jo Nan Liao, Fa Po Chung, Tzeng-Ji Chen, Gregory Y.H. Lip, Shih Ann Chen, Tze Fan Chao*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: Oral anticoagulants (OACs) may serve as a “screening test” for gastrointestinal (GI) tract malignancies through the clinical presentation of bleeding. Objective: The purpose of this study was to investigate the 1-year incidence and predictors of GI cancer after GI bleeding among atrial fibrillation (AF) patients treated with warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). The risks of mortality after GI cancers between patients receiving warfarin and those receiving NOACs were compared. Methods: A total of 10,845 anticoagulated AF patients hospitalized due to GI bleeding without a previous history of GI cancer were identified from the Taiwan National Health Insurance Research Database. Patients were followed-up for incident GI cancers for up to 1 year. Results: Within 1 year after GI bleeding, 290 patients (2.67%) were diagnosed with GI tract cancer. More patients treated with NOACs were diagnosed with GI cancer than those treated with warfarin (3.87% vs 2.44%; P <.001; odds ratio [OR] 1.606; P <.001). Age (OR 1.025 per 1-year increment) and male sex (OR 1.356) were associated with the diagnosis of GI cancer. Among patients diagnosed with GI cancer, 45.2% died within 1 year. The risk of mortality was lower in patients treated with NOACs than in those treated with warfarin (23.5% vs 51.8%; adjusted hazard ratio 0.441; P <.001). Conclusion: Incident GI cancers were diagnosed in 1 of 37 AF patients at 1 year after OAC-related GI bleeding and were more common among patients treated with NOACs (1/26) compared to warfarin (1/41). Detailed examinations for occult GI cancers are necessary, especially among elderly males.

Original languageEnglish
Pages (from-to)1745-1751
Number of pages7
JournalHeart Rhythm
Volume17
Issue number10
DOIs
StatePublished - Oct 2020

Keywords

  • Atrial fibrillation
  • Cancer
  • Gastrointestinal bleeding
  • Non–vitamin K antagonist oral anticoagulant
  • Warfarin

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