{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:07:16Z","timestamp":1789103236599,"version":"build-2803163510"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with cancer and atrial fibrillation (AF) are at increased risk of both thromboembolism and bleeding. However, real-world data evaluating apixaban use in this population remain limited, particularly in Middle Eastern populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational cohort study at a tertiary care center in Saudi Arabia, including adult patients with active cancer or a history of malignancy who received apixaban for non-valvular atrial fibrillation (NVAF) with or without venous thromboembolism (VTE) between August 2016 and October 2020. Thrombotic and bleeding outcomes were assessed within 6 months of apixaban initiation. Baseline demographic and clinical characteristics, cancer-related variables, concomitant therapies, thrombotic events, bleeding outcomes, mortality, and apixaban discontinuation were descriptively analyzed. Bleeding events were classified according to the International Society on Thrombosis and Hemostasis criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final analysis included 72 patients. The mean age was 71.0\u2009\u00b1\u20099.7 years, and 46 patients (63.9%) were female. Active cancer was present in 65 patients (90.3%), while solid tumors accounted for 76.9% of malignancies. Thrombotic events occurred in 7 patients (9.7%), including ischemic stroke in 3 patients and deep vein thrombosis in 3 patients. Bleeding events occurred in 26 patients (36.1%), including major bleeding in 7 patients (9.7%). The most commonly reported bleeding sites were the upper airway and gastrointestinal tract. During follow-up, 21 patients (28.8%) died, most commonly from cancer-related causes. Excluding treatment cessation at the time of death, apixaban was clinically discontinued in 19 patients (26.4%). Documented clinical reasons for discontinuation included bleeding complications, breakthrough thrombotic events requiring a change in anticoagulation therapy, thrombocytopenia, high bleeding risk, and extreme obesity (BMI &amp;gt;50\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Thrombotic and bleeding events were common in this real-world cohort of patients with cancer and AF receiving apixaban. These findings highlight the complexity of anticoagulation management in this high-risk population and support the need for close clinical monitoring and further prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1893856","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T04:31:33Z","timestamp":1789101093000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world safety and clinical outcomes of apixaban in patients with cancer and atrial fibrillation"],"prefix":"10.3389","volume":"13","author":[{"given":"Lolwa S.","family":"Alabdelmuhsin","sequence":"first","affiliation":[{"name":"Pharmaceutical Care Services, Ministry of the National Guard-Health Affairs","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center","place":["Riyadh, Saudi Arabia"]},{"name":"College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Metab F.","family":"Alwethairi","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Services, Ministry of the National Guard-Health Affairs","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center","place":["Riyadh, Saudi Arabia"]},{"name":"College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimah","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Services, Ministry of the National Guard-Health Affairs","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center","place":["Riyadh, Saudi Arabia"]},{"name":"College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ohoud A.","family":"Almadani","sequence":"additional","affiliation":[{"name":"Research Informatics Department, Saudi Food and Drug Authority","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisham A.","family":"Badreldin","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Services, Ministry of the National Guard-Health Affairs","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center","place":["Riyadh, Saudi Arabia"]},{"name":"College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama","family":"Alfehaid","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Services, Ministry of the National Guard-Health Affairs","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah 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