{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:34:16Z","timestamp":1792204456581,"version":"4.4.0"},"reference-count":60,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anticoagulation therapy in patients with atrial fibrillation (AF) and concomitant cancer can be challenging due to the significantly increased risk of both embolism and bleeding. Moreover, the benefits and risks of vitamin K antagonists (VKA, eg. warfarin) versus non\u2010vitamin K antagonist oral anticoagulants (NOACs) in such patients are less well understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From the prospective, global, multi\u2010centered Global Registry on Long\u2010Term Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA\u2010AF), we characterized these patients according to their history of prior cancer when enrolled. All patients received anticoagulant therapy. The primary outcome was the composite of all\u2010cause mortality, stroke, transient ischemic attack, systemic embolism. The secondary endpoints were all\u2010cause mortality, cardiovascular death, stroke, major bleeding and thromboembolism during the 3\u2009years follow\u2010up period. Cox regression analyses were used to calculate the hazard ratio (HR) and confidence interval (CI) following propensity score matching (PSM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, among 16,700 patients enrolled in Phase III in GLORIA\u2010AF, 1725 (10%) patients had concomitant cancer(s) at enrolment. After PSM, the primary outcome occurred in 250 (14.8%) of patients with cancer(s) and 160 (9.3%) without cancer(s) (HR, 1.62 [95% CI, 1.33\u20131.97], <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) during the 3\u2009years follow\u2010up period. The risk of all\u2010cause mortality was significantly higher in patients with cancer(s) versus non\u2010 cancer(s) (HR, 1.71 [95% CI, 1.37\u20132.12], <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). In patients with cancer(s), after PSM, the use of NOACs was associated with reduced risk of the primary outcome compared with that of VKA (HR, .69 [95% CI, .49\u2013.99], <jats:italic>p<\/jats:italic>\u2009=\u2009.043), as well as a lower risk of thromboembolism (HR, .49 [95% CI, .24\u20131.00], <jats:italic>p<\/jats:italic>\u2009=\u2009.051), but the risk of major bleeding was not significantly different (HR, .87 [95% CI, .48\u20131.56], <jats:italic>p<\/jats:italic>\u2009=\u2009.635). Subgroup analysis in patients with cancers showed a reduced risk of major bleeding with NOACs compared with VKA (HR, .18 [95% CI, .04\u2013.8], <jats:italic>p<\/jats:italic>\u2009=\u2009.024) in patients with coronary artery disease (CAD). For the main cancer subtypes (genitourinary, breast, gastrointestinal, haematological and skin), the trends for the risk of primary outcome were consistently favouring NOACs compared with VKA without any significant interaction among these five cancers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cancer is a common comorbidity in patients with AF and is associated with increased risk of composite of all\u2010cause mortality and thromboembolism. Compared with VKA, NOACs was associated with a lower risk of composite events and showed an advantage in lower risk of thromboembolism, as well as a reduced risk of major bleeding when CAD was also present.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.14347","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T05:08:43Z","timestamp":1731560923000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Long\u2010term risks and benefits of oral anticoagulation in atrial fibrillation patients with cancer: A report from the <scp>GLORIA<\/scp>\u2010<scp>AF<\/scp> registry"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9695-6493","authenticated-orcid":false,"given":"Meng","family":"Li","sequence":"first","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University, and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Cardiology, Dongzhimen Hospital Beijing University of Chinese Medicine  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bi","family":"Huang","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University, and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Cardiology The First Affiliated Hospital of Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2147-0995","authenticated-orcid":false,"given":"Steven Ho Man","family":"Lam","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University, and Liverpool Heart and Chest Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Ishiguchi","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University, and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Division of Cardiology, Department of Medicine and Clinical Science Yamaguchi University Graduate School of Medicine, Ube  Yamaguchi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University, and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"The Second Affiliated Hospital of Nanchang University  Nanchang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6044-045X","authenticated-orcid":false,"given":"Brian","family":"Olshansky","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine University of Iowa Hospitals and Clinics  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menno V.","family":"Huisman","sequence":"additional","affiliation":[{"name":"Department of Thrombosis and Hemostasis Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6587-3094","authenticated-orcid":false,"given":"Tze\u2010Fan","family":"Chao","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"Institute of Clinical Medicine and Cardiovascular Research Center National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. 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