Key result
Direct oral anticoagulants were associated with a lower pooled incidence rate of thromboembolic events (4.7% vs 8.7%) compared to vitamin K antagonists in patients with hypertrophic cardiomyopathy and atrial fibrillation.
Why the study?
Limited data were available assessing the efficacy and safety of different anticoagulation strategies for preventing thromboembolic events, major bleeding, and all-cause mortality in patients with HCM and AF.
Does anticoagulation, specifically DOACs, reduce thromboembolic events, major bleeding, and all-cause mortality in patients with concomitant hypertrophic cardiomyopathy and atrial fibrillation compared to no anticoagulation or VKAs?
Systematic Review (n=8,479)
Does anticoagulation, specifically DOACs, reduce thromboembolic events, major bleeding, and all-cause mortality in patients with concomitant hypertrophic cardiomyopathy and atrial fibrillation compared to no anticoagulation or VKAs?
In patients with hypertrophic cardiomyopathy and atrial fibrillation, anticoagulation reduces thromboembolic events compared to no treatment, and DOACs appear superior to VKAs for preventing thromboembolism, major bleeding, and mortality.
OBJECTIVE: Limited data is available assessing the efficacy and safety of different anticoagulation (AC) strategies for prevention of thromboembolic events, major bleeding, and all-cause mortality in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). In this systematic review, we conducted a literature search to examine the possible association between different AC strategies and prevention of these adverse outcomes. METHODS: Scientific databases (PubMed, EMBASE, and Scopus) were searched using relevant medical subject headings and keywords to retrieve studies published through September of 2019. Studies assessing the outcomes of interest in patients with HCM and AF receiving AC, no AC as well as direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) were selected. RESULTS: This review identified 14 observational studies evaluating thromboembolic events by AC strategies in 8,479 participants with concomitant HCM and AF. The use of AC was associated with a lower pooled incidence rate of total thromboembolic events at 9.5% (112 events in 1,175 patients) compared to 22.1% with no AC (108 events in 489 patients). In addition, the use of DOACs was associated with a lower pooled incidence rate of thromboembolic events at 4.7% (169 events in 3,576 patients) compared to 8.7% with VKAs (281 events in 3,239 patients). Furthermore, the use of DOACs compared to VKAs was associated with a lower pooled incidence rate of major bleeding and all-cause mortality at 3.8% (136 events in 3,576 patients) versus 6.8% (220 events in 3,239 patients) and 4.1% (124 events in 3,008 patients) versus 16.1% (384 events in 2,380 patients), respectively. CONCLUSIONS: AC of patients with concomitant HCM and AF was associated with a lower incidence of thromboembolic events when compared to antiplatelet therapy or no treatment. Treatment with DOACs was also associated with a lower incidence of thromboembolic events, major bleeding, and all-cause mortality when compared to VKAs.
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Lozier et al. (2019) conducted a systematic review in Hypertrophic cardiomyopathy and atrial fibrillation (n=8,479). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Incidence of thromboembolic events. Direct oral anticoagulants were associated with a lower pooled incidence rate of thromboembolic events (4.7% vs 8.7%) compared to vitamin K antagonists in patients with hypertrophic cardiomyopathy and atrial fibrillation.
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