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Cohort studyHeart & lung : the journal of critical care · 2026

Anticoagulation strategies and pulmonary safety in patients with active lung cancer and atrial fibrillation: A large-scale, competing risk analysis of 2000 patients.

Ersin Kaya, Tarık Şimşek, İnan Mutlu

Internal MedicineCohort study

Direct Oral Anticoagulants linked to less massive hemoptysis than vitamin K antagonists in lung cancer

Anticoagulation strategies and pulmonary safety in patients with active lung cancer and atrial fibrillation: A large-scale, competing risk analysis of 2000 patients.

Ersin Kaya … İnan Mutlu

Heart & lung : the journal of critical care · 2026

Background

Active lung cancer induces a profound hypercoagulable state.

Purpose

We aimed to evaluate the efficacy-safety trade-off of various anticoagulation strategies and quantify the clinical impact of the "treatment gap" in patients with active lung cancer and comorbid atrial fibrillation (atrial fibrillation).

Methods

This retrospective observational study analyzed 2000 patients with active lung cancer and atrial fibrillation (2018-2025).

n = 2000 patients

Results

massive bleeding was far less common with Direct Oral Anticoagulants than with Vitamin K Antagonists

sHR 0.42 (95% CI 0.24 to 0.72)

CI excludes the null - significant

More results

The untreated cohort (12.7%) exhibited a 13.3% annual ischemic stroke rate.

In Inverse Probability of Treatment Weighting-adjusted analysis, Direct Oral Anticoagulants significantly reduced ischemic stroke risk compared to Vitamin K Antagonists (sHR: 0.42; 95% CI: 0.24-0.72; P = 0.002).

More results

Squamous cell histology significantly interacted with Vitamin K Antagonists use, exacerbating pulmonary bleeding risk (P-interaction=0.002).

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Conclusion · 1 of 3

Direct Oral Anticoagulants offer a superior efficacy-safety profile over Vitamin K Antagonists in patients with active lung cancer and atrial fibrillation.

Conclusion · 2 of 3

The substantial treatment gap observed underscores a high, preventable stroke burden driven by clinical apprehension.

Conclusion · 3 of 3

Direct Oral Anticoagulants-based anticoagulation is a viable, safer strategy even in high-risk thoracic oncology phenotypes.

Post

Anticoagulation strategies and pulmonary safety in patients with active lung cancer and atrial fibrillation: A large-scale, competing risk analysis of 2000 patients.

Direct Oral Anticoagulants linked to less massive hemoptysis than vitamin K antagonists in lung cancer

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