Long-Term Anticoagulation and Outcomes of Head and Neck Cancer: Analysis of the US Nationwide Inpatient Sample

Venous thromboembolism (VTE) is a complication of head and neck cancer (HNC). However, the effectiveness of routine anticoagulation as a preventive measure and its impact on patient outcomes is unclear. The purpose of this study was to evaluate the association between long-term systemic anticoagulation and in-hospital outcomes of patients with HNC. Data of patients ≥ 20 years old with HNC treated from 2005 to 2018 were extracted from the US Nationwide Inpatient Sample (NIS) database. Associations between long-term systemic anticoagulation and in-hospital outcomes were assessed by the univariate and multivariable regression analyses. The study included 20 312 patients with a mean age of 63 years, and 72% were males. Among them, 5078 (25.0%) were on long-term systemic anticoagulation. After adjustment, the multivariable analysis indicated long-term systemic anticoagulation was significantly associated with decreased odds for in-hospital mortality (adjusted odds ratio [aOR] = 0.64, 95% confidence interval [CI]: 0.54-0.76, p < 0.001), overall life-threatening events (aOR = 0.84, 95% CI: 0.78-0.92, p < 0.001), acute myocardial infarction (aOR = 0.76, 95% CI: 0.59-0.97, p = 0.026), sepsis (aOR = 0.80, 95% CI: 0.71-0.90, p < 0.001) and acute kidney injury (aOR = 0.86, 95% CI: 0.76-0.97, p = 0.015). Long-term systemic anticoagulation was significantly associated with elevated overall bleeding risk (aOR = 1.34, 95% CI: 1.17-1.54, p < 0.001) but not intracerebral haemorrhage (ICH) (aOR = 1.65, 95% CI: 0.90-3.04, p = 0.107). In conclusion, in patients with HNC, long-term anticoagulation is associated with better in-hospital outcomes, and does not increase the risk of ICH; however, there is an increased risk of overall bleeding.