Evidence map›Paper›PMID 42411384›Full record

ArticleCancer2026

Direct oral anticoagulants and warfarin in atrial fibrillation patients with cancer by anticoagulation quality.

Danilo Menichelli, Vito Maria Daniele Cormaci, Gianluca Gazzaniga, Irma Bisceglia, Massimiliano Camilli, Daniela Poli, Emilia Antonucci, Roberto Pola, Paolo Santini, Pasquale Pignatelli and 2 more

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In one paragraph

Article in Cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. Article
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

12 authors.

Danilo MenichelliDepartment of General Surgery, Surgical Specialty and Anesthesiology Paride Stefanini, PhD School in Advances in Cardio-Thoracic and Vascular Pathophysiology and Imaging, Sapienza University of Rome, Rome, Italy.
Vito Maria Daniele CormaciDepartment of Medical and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Gianluca GazzanigaDepartment of General Surgery, Surgical Specialty and Anesthesiology Paride Stefanini, PhD School in Advances in Cardio-Thoracic and Vascular Pathophysiology and Imaging, Sapienza University of Rome, Rome, Italy.
Irma BiscegliaIntegrated Cardiology Services, Department of Cardio-Thoracic-Vascular, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
Massimiliano CamilliDepartment of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Daniela PoliDepartment of Critical Care Medicine, Thrombosis Centre, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
Emilia AntonucciArianna Anticoagulazione Foundation, Bologna, Italy.
Roberto PolaThrombosis Unit, Department of Aging, Orthopedic, and Rheumatologic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Paolo SantiniDepartment of General Surgery, Surgical Specialty and Anesthesiology Paride Stefanini, PhD School in Advances in Cardio-Thoracic and Vascular Pathophysiology and Imaging, Sapienza University of Rome, Rome, Italy.ORCID https://orcid.org/0000-0001-9012-5381
Pasquale PignatelliDepartment of Medical and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Daniele PastoriDepartment of Medical and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.ORCID https://orcid.org/0000-0001-6357-5213
START2 Registry Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtrial 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-risk population. The authors compared DOACs with VKAs on mortality, cardiovascular events (CVEs), and bleeding risk across time-in-therapeutic-range (TiTR) strata (< or ≥70%).

methodsAF 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-cause mortality and as subdistribution HR (sHR) for CVEs and bleeding risk. Numbers-needed-to-treat (NNT) and numbers-needed-to-harm (NNH) were calculated. VKA patients were stratified by TiTR <70% or ≥70% and compared with DOACs users.

resultsA total of 1605 patients were included (median, 78 years; 44.7% women). During a mean follow-up of 729.8 days, 153 deaths, 177 CVEs, and 90 bleedings occurred. After PSM, DOACs were associated with lower all-cause mortality (HR, 0.37, p < .001) and CVEs (sHR 0.58, p = .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 <70%, and with lower mortality, similar CVEs risk and higher risk of bleeding for a TiTR ≥70%.

conclusionDOACs may reduce mortality in AF patients with cancer regardless TiTR. The use of DOACs in high-bleeding risk patients with good TiTR should be cautious.

Indexed as

AnticoagulantsAtrial FibrillationNeoplasmsWarfarinAdministration, OralAgedAged, 80 and overFemaleHemorrhageHumansItalyMaleStrokeVitamin KAnticoagulantsVitamin KWarfarinatrial fibrillationcancercardiovascular eventsdirect oral anticoagulantsmortality

Identifiers

PMID42411384
PMCPMC13338909

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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.