Prescription of
anticoagulants (ACs) in patients with
cancer and
atrial fibrillation (AF) is challenging and the impact on survival is not defined. In this study data prospectively collected in Oncology Units were retrospectively evaluated. Among 4664 patients admitted for
malignancy, 394 patients (8.4%) had documented AF (mean age of 74 ± 9) and AC was prescribed to 155 patients (40%). Neither the type of
cancer, the stage of the disease (metastatic or not) nor the ongoing treatments were significantly associated with prescription of AC, which was independently associated with BMI (OR 1.10; CI 95% 1.03-1.17; p = .003),
valvular heart disease (OR 3.76; CI95% 1.59-8.87; p = .002), and previous
venous thromboembolism (OR 6.67; 95%CI 2.67-16.70; p < .001). During a median follow-up of 212 days, survival from all-cause death was 37%, 28% and 18% at 6 months, 1 and 2 years, respectively. Only variables related to neoplastic disease or to patient clinical complexity were independently associated with mortality. A CHA2DS2VASc ≥ 4 was significantly associated with mortality (HR 1.33; 95%CI 1.06-1.67; p = .013). Treatment with ACs was not significantly related to mortality, neither in the whole cohort of patients, nor in patients with metastatic
malignancies. In conclusion the prescription of ACs in patients with AF and active
cancer was suboptimal, with one fourth of the patients not treated with ACs and one third using
LMWH at prophylactic, non-therapeutic doses. Only few variables (BMI,
valvular heart disease and previous
venous thromboembolism) predicted prescription of ACs. Prescription of ACs was not associated with all-cause mortality, even in the subgroup with
metastasis.