(B-137) Contemporary Trends in Oral Anticoagulant Use Among Patients with Atrial Fibrillation and Cancer in UK Primary Care

Background: Anticoagulation is essential for patients with atrial fibrillation (AF) and cancer due to their elevated risk of stroke. However, patterns of oral anticoagulant (OAC) use in this population remain unclear.

Objectives: This study examined contemporary trends in OAC prescriptions and factors associated with OAC initiation in patients with AF and cancer in UK primary care from 2010 to 2023.

Methods: Using the Clinical Practice Research Datalink (CPRD), we assembled a population-based cohort of patients aged ≥50 years diagnosed with AF between 2010 and 2023, who had a prior or concurrent cancer diagnosis (except non-melanoma skin cancer). All OAC prescriptions recorded during the study period were identified. We estimated the annual proportion of patients who initiated OACs within a year of AF diagnosis, overall and stratified by OAC type (direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs)), sex, age groups (50–59, 60–69, 70–79, ≥80), history of stroke, cancer type, presence of metastasis, anemia, dementia, chronic kidney disease and active cancer (defined as cancer diagnosed within two years before AF diagnosis). Factors associated with OAC initiation were assessed using multivariate logistic regression.

Results: The cohort included 19,891 patients with AF and cancer, of whom 13,123 (66%) initiated an OAC within the first year of AF diagnosis. The median time from AF diagnosis to OAC initiation was 23 days (interquartile range: 7–90). The proportion of patients initiating OACs increased from 42.3% in 2010 to 78.5% in 2023, driven by a sharp increase in DOAC prescriptions (0.07% in 2010 to 77.5% in 2023), while VKA prescriptions declined (42.2% in 2010 to 0.9% in 2023). In 2023, apixaban was the most prescribed DOAC (52.6%), followed by edoxaban (20.2%), rivaroxaban (4.6%), and dabigatran (0.07%). OAC prescriptions also increased in both sexes and most age groups, except for those aged 50–59 years. OAC initiation was less common in patients with hematologic, lung, metastatic or active cancer, and in those with comorbidities such as anemia, dementia, or chronic kidney disease. In contrast, patients with prostate or breast cancer and those with a history of stroke were more likely to receive OACs.

Conclusions: In recent years, DOACs have largely replaced VKAs as the preferred anticoagulant for stroke prevention in patients with AF and cancer in the UK, with apixaban and edoxaban being the most prescribed. However, OAC initiation remains lower among patients with active cancer or comorbidities beyond AF and cancer.