Direct oral anticoagulants showed a similar risk of thromboembolic events (RR 0.93) compared to vitamin K antagonists in patients with hypertrophic cardiomyopathy and atrial fibrillation.
Meta-Analysis (n=9,395)
Yes
Does DOAC therapy reduce thromboembolic events and bleeding compared to VKA therapy in patients with hypertrophic cardiomyopathy and atrial fibrillation?
In patients with hypertrophic cardiomyopathy and atrial fibrillation, DOACs are as effective as VKAs for preventing thromboembolic events but offer a superior safety profile with significantly lower risks of intracranial hemorrhage and mortality.
Effect estimate: RR 0.93 (95% CI 0.73-1.20)
p-value: p=0.59
BACKGROUND: The benefit-risk profile of direct oral anticoagulants (DOAC) therapy in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) has not been well established yet. This study aimed to evaluate the efficacy and safety of DOAC compared with vitamin K antagonists (VKA) in patients with HCM and AF. METHODS: PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing DOAC with VKA in patients with HCM and AF. The primary endpoint was thromboembolic events. The relative risks and standard errors were pooled by random-effect models using the generic inverse variance method. RESULTS: Seven observational studies involving 9395 patients were included in this meta-analysis. Compared to the VKA group, the DOAC group displayed a similar risk of thromboembolic events RR (95%CI): 0.93 (0.73-1.20), p = 0.59 and ischemic stroke RR (95%CI): 0.65 (0.33-1.28), p = 0.22. The incidence of major bleeding was comparable between the two groups RR (95%CI): 0.75 (0.49-1.15), p = 0.19. Meanwhile, DOAC therapy was superior to VKA therapy in reducing the incidences of all-cause death RR (95%CI): 0.44 (0.35-0.55), p < 0.001, cardiovascular death RR (95%CI): 0.41 (0.22-0.75), p = 0.004, and intracranial hemorrhage RR (95%CI): 0.42 (0.24-0.74), p = 0.003. CONCLUSION: In patients with HCM and AF, DOAC therapy was similar to VKA therapy in reducing the risk of thromboembolic events, without increasing bleeding risk. In addition, the DOAC group displayed significant advantages in reducing mortality and intracranial hemorrhage compared with the VKA group. Further randomized controlled trials are needed to provide more evidence for DOAC therapy in this population.
Lyu et al. (Tue,) conducted a meta-analysis in Hypertrophic cardiomyopathy and atrial fibrillation (n=9,395). Direct oral anticoagulants (DOAC) vs. Vitamin K antagonists (VKA) was evaluated on Thromboembolic events (RR 0.93, 95% CI 0.73-1.20, p=0.59). Direct oral anticoagulants showed a similar risk of thromboembolic events (RR 0.93) compared to vitamin K antagonists in patients with hypertrophic cardiomyopathy and atrial fibrillation.