临床前动物研究表明，骨髓细胞合成的凝血因子 X 会抑制抗肿瘤免疫，而直接 Xa 因子抑制剂利伐沙班可用于促进肿瘤免疫。本研究旨在评估服用直接 Xa 因子抑制剂的房颤患者是否比服用直接凝血酶抑制剂达比加群的患者具有更低的癌症风险和癌症相关死亡率。 这项在丹麦进行的全国性人群队列研究包括成年房颤患者没有癌症病史，在 2011 年至 2015 年间开始服用 Xa 因子抑制剂或达比加群。有关病史、结果和药物使用的数据是通过丹麦医疗保健登记处获得的。主要结果是任何癌症。次要结局是癌症相关死亡率和全因死亡率。在意向治疗分析中评估了 5 年随访期间的结果事件。基于倾向评分的治疗加权逆概率用于计算累积发生率和亚分布风险比 (SHR) 以及相应的 95% 置信区间 (CI)，其中死亡作为竞争事件。使用逻辑回归估计倾向得分，包括模型性别、索引日期的年龄组、合并症和药物的使用。总共纳入了 11,742 名开始使用 Xa 因子抑制剂的房颤患者和 11,970 名开始使用达比加群的患者。 Xa 因子队列的平均年龄为 75.2 岁（标准差 [SD] 11.2），达比加群队列的平均年龄为 71.7 岁（SD 11.1）。根据倾向评分加权模型，经过5年的随访，Xa因子抑制剂之间的癌症累积发病率没有观察到显着差异（2,157/23,711；9.11%，95% CI [8.61%， 9.63%]）和达比加群（2,294/23,715；9.68%，95% CI [9.14%,10.25%]）组（SHR 0.94，95% CI [0.89,1.00]，P 值 0.0357）。我们观察到癌症相关死亡率没有差异（因子 Xa 抑制剂队列 1,028/23,711；4.33%，95% CI [4.02%,4.68%]。达比加群队列 1,001/23,715；4.22%，95% CI [3.83%，4.66%] ]；SHR 1.03，95% CI [0.94,1.12]），但 Xa 因子抑制剂队列的全因死亡率较高（Xa 因子抑制剂队列 7,416/23,711；31.31%，95% CI [30.37%,32.29%]达比加群队列 6,531/23,715；27.56%，95% CI [26.69%,28.45%]；HR 1.17，95% CI [1.13,1.21]。该研究的主要局限性是残留混杂的可能性和较短的随访期。在这项基于人群的队列研究中，与达比加群相比，Xa 因子抑制剂的使用与总体较低的癌症发生率或癌症相关死亡率无关。 。我们确实观察到 Xa 因子抑制剂队列的全因死亡率有所增加。版权所有：© 2024 Bosch 等人。这是一篇根据知识共享署名许可条款分发的开放获取文章，允许在任何媒体上不受限制地使用、分发和复制，前提是注明原始作者和来源。

Preclinical animal studies have suggested that myeloid cell-synthesized coagulation factor X dampens antitumor immunity and that rivaroxaban, a direct factor Xa inhibitor, can be used to promote tumor immunity. This study was aimed at assessing whether patients with atrial fibrillation taking direct factor Xa inhibitors have lower risk of cancer and cancer-related mortality than patients taking the direct thrombin inhibitor dabigatran.This nationwide population-based cohort study in Denmark included adult patients with atrial fibrillation and without a history of cancer, who started taking a factor Xa inhibitor or dabigatran between 2011 and 2015. Data on medical history, outcomes, and drug use were acquired through Danish healthcare registries. The primary outcome was any cancer. Secondary outcomes were cancer-related mortality and all-cause mortality. Outcome events were assessed during 5 years of follow-up in an intention-to-treat analysis. The propensity score-based inverse probability of treatment weighting was used to compute cumulative incidence and subdistribution hazard ratios (SHRs) and corresponding 95% confidence intervals (CIs), with death as a competing event. Propensity scores were estimated using logistic regression and including in the model sex, age group at index date, comorbidities, and use of comedications. A total of 11,742 patients with atrial fibrillation starting a factor Xa inhibitor and 11,970 patients starting dabigatran were included. Mean age was 75.2 years (standard deviation [SD] 11.2) in the factor Xa cohort and 71.7 years (SD 11.1) in the dabigatran cohort. On the basis of the propensity score-weighted models, after 5 years of follow-up, no substantial difference in the cumulative incidence of cancer was observed between the factor Xa inhibitor (2,157/23,711; 9.11%, 95% CI [8.61%,9.63%]) and dabigatran (2,294/23,715; 9.68%, 95% CI [9.14%,10.25%]) groups (SHR 0.94, 95% CI [0.89,1.00], P value 0.0357). We observed no difference in cancer-related mortality (factor Xa inhibitors cohort 1,028/23,711; 4.33%, 95% CI [4.02%,4.68%]. Dabigatran cohort 1,001/23,715; 4.22%, 95% CI [3.83%,4.66%]; SHR 1.03, 95% CI [0.94,1.12]), but all-cause mortality was higher in the factor Xa inhibitor cohort (factor Xa inhibitors cohort 7,416/23,711; 31.31%, 95% CI [30.37%,32.29%]. Dabigatran cohort 6,531/23,715; 27.56%, 95% CI [26.69%,28.45%]; HR 1.17, 95% CI [1.13,1.21]). The main limitations of the study were the possibility of residual confounding and the short follow-up period.In this population based cohort study, factor Xa inhibitor use was not associated with an overall lower incidence of cancer or cancer-related mortality when compared to dabigatran. We did observe an increase in all-cause mortality in the factor Xa inhibitor cohort.Copyright: © 2024 Bosch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.