Abstract
Although previous studies demonstrated the risk of ischemic stroke (IS) in patients with head and neck cancer (HNC), the impact of oral antithrombotic therapy (OAT) on this risk has not yet been assessed. We aimed to evaluate the effectiveness and safety of OAT in patients with HNC treated with RT. This retrospective cohort study was performed using the National Health Insurance Research Database of Taiwan. A total of 37,638 patients diagnosed with HNC included in the study were classified as users and nonusers of OAT. Primary outcome was IS or transient ischemic attack (TIA), and secondary outcomes were death and major bleeding. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). There was no significant difference in the risk of IS or TIA between patients on continuous OAT and nonusers (adjusted HR, 0.812; 95% CI, 0.199–3.309). The risk of major bleeding was not significantly different between the groups. From a national population database, we did not find an association between OAT and decreasing risk of ischemic stroke/TIA or increasing hazard of major bleeding.
Highlights
In Taiwan, head and neck cancer (HNC), which is diagnosed in more than 8,000 patients every year, is a leading cause of death [1, 2]
We identified 37,638 patients with HNC treated with radiation therapy (RT) within the defined time interval
No significant differences in the risk for death from any cause or major bleeding were found between users and nonusers by univariate or multivariate analyses using the Cox proportional hazards model and follow-up methods I and II (Table 3). In this population-based cohort study to examine the efficacy and safety of oral antithrombotic therapy (OAT) in patients with HNC treated with RT, we found that OAT did not significantly reduce the risk of the primary outcome of this study, that is, ischemic stroke and transient ischemic attack (TIA)
Summary
In Taiwan, head and neck cancer (HNC), which is diagnosed in more than 8,000 patients every year, is a leading cause of death [1, 2]. Radiation triggers an inflammatory response and precipitates damage to the vessel wall, eventually leading to the thickening of arterial walls, plaque formation, thrombosis, and altered blood flow or occlusion and stenosis of the artery. These disturbances in the vascular system are known to increase the risk of ischemic stroke and transient ischemic attack (TIA) [4]. Several studies have shown that RT in patients with HNC increased the risk of ischemic stroke and TIA [5,6,7,8,9,10]
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