Arrhythmias & electrophysiology
Bleeding and New Malignancy Diagnoses After Anticoagulation for Atrial Fibrillation: A Population-Based Cohort Study
Main finding · Incident malignancyResult — go to the resultHazard ratio 4.0 95% CI 3.8–4.3Authors' conclusion
In anticoagulated patients with AF, bleeding was strongly associated with new cancer diagnoses. Antecedent bleeding was associated with cancer diagnosis at an earlier stage.
Study context
- Population
- People ≥66 years newly initiating warfarin or DOACs after atrial fibrillation (AF) diagnosis, 2008–2022; excluded valvular disease, chronic dialysis, VTE, previous cancer or previously documented bleedingmean age 77.4 y
- Participants
- 119,480 people
- Exposure
- Bleeding vs no bleeding after starting OAC for AF
- Bleedingn = 26,037
- Outcome
- Incident malignancy
- Follow-up
- 2 years after starting anticoagulation
Methodological detailslinked administrative data sets, bleeding as time-varying covariate, cause-specific regression models
- Linked administrative data sets
- Bleeding as time-varying covariate
- Cause-specific regression models
Main finding
As reported in the abstract
2 years
Hazard ratio
4.0
95% CI 3.8–4.3
Bleedingvs Without bleeding
HR 4.0 (95% CI 3.8–4.3)
- Diagnosed with malignancy within 2 years (all participants)
- 5800 (4.9%)
Observational data: associations, not effects.
Further findings
Any malignancy, by bleeding site · 2 years
| HR (95% CI) | ||
|---|---|---|
| GastrointestinalGastrointestinal bleeds | 5.0 (4.6–5.5) | |
| GenitourinaryGenitourinary bleeds | 5.0 (4.4–5.7) | |
| RespiratoryRespiratory bleeds | 4.0 (3.5–4.6) | |
| IntracranialIntracranial bleeds | 1.8 (1.4–2.2) | |
| NasopharyngealNasopharyngeal bleeds | 1.5 (1.2–2.0) | |
| 0.20.5125Hazard ratio (log scale) |
Cancers concordant with bleeding site
| HR | |
|---|---|
| Gastrointestinal | 15.4 |
| Genitourinary | 11.8 |
| Respiratory | 10.1 |
| Outcome | Without bleeding | P value |
|---|---|---|
| Stage 4 at cancer diagnosisAfter bleeding vs Without bleeding · earlier stage after bleeding | 31.3% | P = 0.029 |
- Stage 4 at cancer diagnosis: After bleeding 27.6%
Original publication
Bleeding and New Malignancy Diagnoses After Anticoagulation for Atrial Fibrillation: A Population-Based Cohort Study. Circulation. Published 20 February 2025. doi:10.
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