Effectiveness and Safety of Apixaban Versus Warfarin in Atrial Fibrillation Patients With Malignancy: A Propensity-Matched Analysis
Recommended Citation
Agrawal SP, Tated R, Jain H, Soni K, Joshi DK, Futela P, Raval M, Aggarwal V, Deshmukh A, Vallabhajosyula S. Effectiveness and Safety of Apixaban Versus Warfarin in Atrial Fibrillation Patients with Malignancy: A Propensity-Matched Analysis. Am J Cardiol. 2026;264:14-20.
Document Type
Article
Publication Date
4-1-2026
Publication Title
The American journal of cardiology
Keywords
Humans, Pyridones, Atrial Fibrillation, Warfarin, Pyrazoles, Male, Female, Aged, Retrospective Studies, Propensity Score, Anticoagulants, Neoplasms, Factor Xa Inhibitors, Stroke, Middle Aged, Treatment Outcome, Pulmonary Embolism, Thromboembolism, Aged, 80 and over, Survival Rate
Abstract
Patients with atrial fibrillation and malignancy have increased risks of thromboembolism and bleeding. Evidence comparing apixaban and warfarin in this group remains limited. We aimed to compare effectiveness and safety of apixaban versus warfarin in patients with atrial fibrillation and active malignancy using real-world data from a large multinational cohort. This retrospective cohort study used the TriNetX Global Collaborative Network, de-identified records from 146 healthcare organizations between December 1, 2012, and May 1, 2025. Atrial fibrillation patients with malignancy receiving apixaban or warfarin were matched 1:1 using propensity scores across 74 clinical variables. Outcomes were assessed at 3 months, 6 months, 1 year, and 5 years. Primary endpoints included all-cause mortality, stroke, pulmonary embolism, deep vein thrombosis, gastrointestinal bleeding and intracranial hemorrhage. In this 12.5-year period, 41,764 matched pairs of patients were analyzed. Compared to the warfarin cohort, the apixaban cohort demonstrated lower all-cause mortality at 3 months (OR: 1.05, 95% CI: 1.00-1.10), 6 months (OR: 1.05, 95% CI: 1.01-1.09), 1 year (OR: 1.06, 95% CI: 1.03-1.10), and 5 years (OR: 1.17, 95% CI: 1.13-1.20; all p < 0.05). Stroke rates were comparable between groups, while pulmonary embolism, deep vein thrombosis, gastrointestinal bleeding and intracranial hemorrhage were noted less frequent with apixaban. Kaplan-Meier analyses showed early and sustained differences in survival and bleeding outcomes. In conclusion, in atrial fibrillation patients with cancer, apixaban was associated with lower mortality and major bleeding without increasing stroke risk compared to warfarin.
Medical Subject Headings
Humans; Pyridones; Atrial Fibrillation; Warfarin; Pyrazoles; Male; Female; Aged; Retrospective Studies; Propensity Score; Anticoagulants; Neoplasms; Factor Xa Inhibitors; Stroke; Middle Aged; Treatment Outcome; Pulmonary Embolism; Thromboembolism; Aged, 80 and over; Survival Rate
PubMed ID
41554390
Volume
264
First Page
14
Last Page
20
