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Peer-reviewedCC BY 4.0JACC: Advances

Trends in Oral Anticoagulant Prescribing for Atrial Fibrillation and Active Cancer in UK Primary Care

  • Joseph Junior Damba, MD, MSc1
  • Sarah Beradid, MSc2
  • Laurent Azoulay, PhD3
  • James M. Brophy, MD, PhD4
  • Christel Renoux, MD, PhD
4 affiliations
  1. 1Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
  2. 2Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
  3. 3Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada; Gerald Bronfman Department of Oncology, McGill University, Montréal, Québec, Canada
  4. 4Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada; Division of Cardiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
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Abstract

Background: Anticoagulation is essential in patients with atrial fibrillation (AF) and cancer, but recent real-world evidence on oral anticoagulant (OAC) use remains limited. Objectives: This study aims to describe recent OAC-prescribing trends and identify factors associated with OAC initiation in patients with AF and active cancer in UK primary care. Methods: Using the Clinical Practice Research Datalink, we identified patients aged ≥50 years with incident AF (cohort entry) between 2010 and 2023 and active cancer diagnosed in the year before cohort entry. We calculated OAC initiation rates in the year following AF diagnosis among eligible patients (CHA 2 DS 2 -VASc ≥2) using Poisson regression, overall and stratified by OAC type, age, sex, and cancer characteristics. Cox proportional hazards regression was used to identify factors associated with OAC initiation. Results: Among 12,254 eligible patients, 6,940 (56.6%) initiated an OAC. OAC initiation rates rose from 89 per 100 person-years in 2010 to 385 per 100 person-years in 2023 (adjusted rate ratio: 4.32; 95% CI: 3.78-4.93), driven by increased direct oral anticoagulant prescribing. By 2023, apixaban and edoxaban predominated. OAC initiation did not differ by age and sex but was less common in patients with lung cancer (HR: 0.74; 95% CI: 0.67-0.82), metastatic cancer (HR: 0.66; 95% CI: 0.51-0.87), and dementia (HR: 0.75; 95% CI: 0.64-0.88). Conclusions: In the last decade, OAC initiation has substantially increased among eligible patients with AF and active cancer, driven by direct oral anticoagulant uptake. However, OAC initiation remained lower among patients with lung cancer, metastatic cancer, or specific comorbidities.

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Cite

BibTeXRIS
BibTeX
@article{josephjuniordamba2026trends,
  title = {{Trends in Oral Anticoagulant Prescribing for Atrial Fibrillation and Active Cancer in UK Primary Care}},
  author = {Joseph Junior Damba, MD, MSc and Sarah Beradid, MSc and Laurent Azoulay, PhD and James M. Brophy, MD, PhD and Christel Renoux, MD, PhD},
  journal = {JACC: Advances},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jacadv.2026.103372},
  url = {https://doi.org/10.1016/j.jacadv.2026.103372},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Trends in Oral Anticoagulant Prescribing for Atrial Fibrillation and Active Cancer in UK Primary Care
AU  - Joseph Junior Damba, MD, MSc
AU  - Sarah Beradid, MSc
AU  - Laurent Azoulay, PhD
AU  - James M. Brophy, MD, PhD
AU  - Christel Renoux, MD, PhD
PY  - 2026
DA  - 2026/10/23
JO  - JACC: Advances
DO  - 10.1016/j.jacadv.2026.103372
UR  - https://doi.org/10.1016/j.jacadv.2026.103372
AB  - Background: Anticoagulation is essential in patients with atrial fibrillation (AF) and cancer, but recent real-world evidence on oral anticoagulant (OAC) use remains limited. Objectives: This study aims to describe recent OAC-prescribing trends and identify factors associated with OAC initiation in patients with AF and active cancer in UK primary care. Methods: Using the Clinical Practice Research Datalink, we identified patients aged ≥50 years with incident AF (cohort entry) between 2010 and 2023 and active cancer diagnosed in the year before cohort entry. We calculated OAC initiation rates in the year following AF diagnosis among eligible patients (CHA 2 DS 2 -VASc ≥2) using Poisson regression, overall and stratified by OAC type, age, sex, and cancer characteristics. Cox proportional hazards regression was used to identify factors associated with OAC initiation. Results: Among 12,254 eligible patients, 6,940 (56.6%) initiated an OAC. OAC initiation rates rose from 89 per 100 person-years in 2010 to 385 per 100 person-years in 2023 (adjusted rate ratio: 4.32; 95% CI: 3.78-4.93), driven by increased direct oral anticoagulant prescribing. By 2023, apixaban and edoxaban predominated. OAC initiation did not differ by age and sex but was less common in patients with lung cancer (HR: 0.74; 95% CI: 0.67-0.82), metastatic cancer (HR: 0.66; 95% CI: 0.51-0.87), and dementia (HR: 0.75; 95% CI: 0.64-0.88). Conclusions: In the last decade, OAC initiation has substantially increased among eligible patients with AF and active cancer, driven by direct oral anticoagulant uptake. However, OAC initiation remained lower among patients with lung cancer, metastatic cancer, or specific comorbidities.
SN  - 2772-963X
ER  -