Evidence map›Paper›PMID 29378726›Full record

ArticleBlood advances2018

Comparative effectiveness of direct oral anticoagulants and warfarin in patients with cancer and atrial fibrillation.

Surbhi Shah, Faye L Norby, Yvonne H Datta, Pamela L Lutsey, Richard F MacLehose, Lin Y Chen, Alvaro Alonso

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Blood advances, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
90citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

90 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  8. The Net Clinical Benefit of Rivaroxaban Compared to Low-Molecular-Weight Heparin in the Treatment of Cancer-Associated Thrombosis: Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Pooled it
  9. Cost-effectiveness Evaluations Among the Direct Oral Anticoagulants for the Prevention and Treatment of Venous Thromboembolism: Systematic Review.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Pooled it
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  14. Intravenous thrombolysis in the context of stroke and cancer.Journal of thrombosis and thrombolysis · 2025
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30 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Surbhi ShahDepartment of Medicine, University of Minnesota Medical School, Minneapolis, MN.
Faye L NorbyDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; and.
Yvonne H DattaDepartment of Medicine, University of Minnesota Medical School, Minneapolis, MN.
Pamela L LutseyDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; and.
Richard F MacLehoseDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; and.
Lin Y ChenDepartment of Medicine, University of Minnesota Medical School, Minneapolis, MN.
Alvaro AlonsoDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.

Funding

Contemporary Venous Thromboembolism TreatmentR01HL131579 · NHLBI · UNIVERSITY OF MINNESOTA · PI LUTSEY, PAMELA L. · 2017 to 2020
$1.9M
Comparative Effectiveness of Oral Anticoagulants in Atrial FibrillationR01HL122200 · NHLBI · UNIVERSITY OF MINNESOTA · PI ALONSO, ALVARO · 2015 to 2017
$1.2M
NHLBI NIH HHS R01 HL122200NHLBI NIH HHS R01 HL131579
6 · The paper itself

Abstract

Randomized clinical trials comparing direct oral anticoagulants (DOACs) to warfarin in cancer patients have not been performed. We evaluated the effectiveness and associated risk of DOACs vs warfarin, as well as comparisons of DOACs, in a large population of cancer patients with nonvalvular atrial fibrillation (AF). Using the MarketScan databases, we identified 16 096 AF patients (mean age, 74 years) initiating oral anticoagulant and being actively treated for cancer between 2010 and 2014. Anticoagulant users were matched by age, sex, enrollment date, and drug initiation date. Study end points were identified with diagnostic codes and included ischemic stroke, severe bleeding, other bleeding, and venous thromboembolism (VTE). Cox regression was used to estimate associations of anticoagulants with study end points. Compared with warfarin, rates of bleeding (hazard ratio [95% confidence interval]) were similar in rivaroxaban (1.09 [0.79, 1.39]) and dabigatran (0.96 [0.72, 1.27]) users, whereas apixaban users experienced lower rates (0.37 [0.17, 0.79]). Rates of ischemic stroke did not differ among anticoagulant users. Compared with warfarin, rate of VTE (hazard ratio [95% confidence interval]) was lower among rivaroxaban (0.51 [0.41, 0.63]), dabigatran (0.28 [0.21, 0.38]), and apixaban (0.14 [0.07, 0.32]) users. In head-to-head comparisons among DOACs, dabigatran users had lower rates of VTE than rivaroxaban users; apixaban users had lower rates of VTE and severe bleeding than rivaroxaban users. In this population of patients with AF and cancer, DOAC users experienced lower or similar rates of bleeding and stroke compared with warfarin users, and a lower rate of incident VTE.

Indexed as

Administration, OralAdolescentAdultAgedAged, 80 and overAnticoagulantsAtrial FibrillationDabigatranDatabases, FactualHemorrhageHumansMiddle AgedNeoplasmsRetrospective StudiesRivaroxabanStrokeAnticoagulantsDabigatranRivaroxabanWarfarin

Identifiers

PMID29378726
PMCPMC5812321

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.