{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:15:26Z","timestamp":1788952526184,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"14","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2026,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atrial fibrillation (AF) patients with cancer are frequently treated with vitamin K antagonists (VKAs). Direct oral anticoagulants (DOACs) benefit according to VKA quality has not been investigated in this high\u2010risk population. The authors compared DOACs with VKAs on mortality, cardiovascular events (CVEs), and bleeding risk across time\u2010in\u2010therapeutic\u2010range (TiTR) strata (&lt; or \u226570%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AF patients with cancer from the nationwide Italian Survey on Anticoagulated Patients Register on oral anticoagulants were included. Propensity score matching (PSM) was performed. Results were expressed as hazard ratio (HR) and 95% confidence interval (CI) for all\u2010cause mortality and as subdistribution HR (sHR) for CVEs and bleeding risk. Numbers\u2010needed\u2010to\u2010treat (NNT) and numbers\u2010needed\u2010to\u2010harm (NNH) were calculated. VKA patients were stratified by TiTR\u00a0&lt;70%\u00a0or \u226570% and compared with DOACs users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1605 patients were included (median, 78 years; 44.7% women). During a mean follow\u2010up of 729.8 days, 153 deaths, 177 CVEs, and 90 bleedings occurred. After PSM, DOACs were associated with lower all\u2010cause mortality (HR, 0.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) and CVEs (sHR 0.58,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.005) and similar bleeding risk compared to VKAs. The lowest NNT was observed at 24 months (28.2 for mortality and 37.8 for CVEs), whereas NNH was not significant. DOAC use was associated with lower mortality and CVEs risk in patients with TiTR &lt;70%, and with lower mortality, similar CVEs risk and higher risk of bleeding for a TiTR \u226570%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DOACs may reduce mortality in AF patients with cancer regardless TiTR. The use of DOACs in high\u2010bleeding risk patients with good TiTR should be cautious.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.70501","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T10:17:38Z","timestamp":1783419458000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct oral anticoagulants and warfarin in atrial fibrillation patients with cancer by anticoagulation quality"],"prefix":"10.1002","volume":"132","author":[{"given":"Danilo","family":"Menichelli","sequence":"first","affiliation":[{"name":"Department of General Surgery, Surgical Specialty and Anesthesiology Paride Stefanini, PhD School in Advances in Cardio\u2010Thoracic and Vascular Pathophysiology and Imaging Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito Maria Daniele","family":"Cormaci","sequence":"additional","affiliation":[{"name":"Department of Medical and Cardiovascular Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Gazzaniga","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Surgical Specialty and Anesthesiology Paride Stefanini, PhD School in Advances in Cardio\u2010Thoracic and Vascular Pathophysiology and Imaging Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irma","family":"Bisceglia","sequence":"additional","affiliation":[{"name":"Integrated Cardiology Services, Department of Cardio\u2010Thoracic\u2010Vascular Azienda Ospedaliera San Camillo Forlanini  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Camilli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart  Rome Italy"},{"name":"Department of Cardiovascular Sciences CUORE Fondazione Policlinico Universitario A. Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Poli","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Thrombosis Centre Azienda Ospedaliera Universitaria Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Antonucci","sequence":"additional","affiliation":[{"name":"Arianna Anticoagulazione Foundation  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Pola","sequence":"additional","affiliation":[{"name":"Thrombosis Unit, Department of Aging, Orthopedic, and Rheumatologic Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9012-5381","authenticated-orcid":false,"given":"Paolo","family":"Santini","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Surgical Specialty and Anesthesiology Paride Stefanini, PhD School in Advances in Cardio\u2010Thoracic and Vascular Pathophysiology and Imaging Sapienza University of Rome  Rome Italy"},{"name":"Thrombosis Unit, Department of Aging, Orthopedic, and Rheumatologic Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Pignatelli","sequence":"additional","affiliation":[{"name":"Department of Medical and Cardiovascular Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6357-5213","authenticated-orcid":false,"given":"Daniele","family":"Pastori","sequence":"additional","affiliation":[{"name":"Department of Medical and Cardiovascular Sciences Sapienza University of Rome  Rome Italy"},{"name":"IRCCS Neuromed  Pozzilli (IS) Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the START2 Registry 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