Key result
Compared with vitamin K antagonists, direct oral anticoagulants significantly reduced the risk of stroke or systemic embolism by 34% (RR 0.66) in patients with atrial fibrillation and cancer.
Why the study?
The effectiveness and safety of DOACs compared with VKAs in patients with cancer and AF remain controversial.
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism in patients with nonvalvular atrial fibrillation and cancer compared to vitamin K antagonists?
Meta-Analysis (n=248,218)
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism in patients with nonvalvular atrial fibrillation and cancer compared to vitamin K antagonists?
Relative Risk: 0.66 (95% CI 0.54–0.8)
In patients with atrial fibrillation and cancer, DOACs are associated with lower risks of stroke, systemic embolism, venous thromboembolism, and intracranial hemorrhage compared to VKAs, supporting their use in this high-risk population.
DOACs may be preferable to VKAs in cancer-associated AF; leaves open need for dedicated RCTs in this population.
Background: The use of direct oral anticoagulants (DOACs) is recommended as the preferred treatment drug in patients with nonvalvular atrial fibrillation (AF). However, the effectiveness and safety of DOACs compared with vitamin K antagonists (VKAs) in patients with cancer and AF are still controversial. Therefore, we performed a meta-analysis regarding the effectiveness and safety of DOACs vs. VKAs in AF patients with cancer. Methods: A search of the Pubmed and EMBASE databases until August 2021 was performed. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model with an inverse variance method. Results: Thirteen studies were deemed to meet the criteria. For the effectiveness outcomes, the use of DOACs compared with VKAs use was significantly associated with decreased risks of stroke or systemic embolism (RR = 0.66, 95% CI: 0.54–0.80) and venous thromboembolism (RR = 0.40, 95% CI: 0.26–0.61), but not ischemic stroke (RR = 0.79, 95% CI: 0.56–1.11), myocardial infarction (RR = 0.78, 95% CI: 0.56–1.11), cardiovascular death (RR = 0.76, 95% CI: 0.53–1.09), and all-cause death (RR = 0.82, 95% CI: 0.43–1.56). For the safety outcomes, compared with VKAs use, the use of DOACs was associated with reduced risks of intracranial bleeding (RR = 0.60, 95% CI: 0.50–0.71) and gastrointestinal bleeding (RR = 0.87, 95% CI: 0.80–0.95). There were no significant differences in major bleeding (RR = 0.87, 95% CI: 0.74–1.04), major or nonmajor clinically relevant bleeding (RR = 0.87, 95% CI: 0.74–1.01), and any bleeding (RR = 0.88, 95% CI: 0.76–1.03). Conclusion: Compared with VKAs, DOACs appeared to have significant reductions in stroke or systemic embolism, venous thromboembolism, intracranial bleeding, and gastrointestinal bleeding, but comparable risks of ischemic stroke, myocardial infarction, cardiovascular death, all-cause death, major bleeding, major or nonmajor clinically relevant bleeding, and any bleeding in patients with AF and cancer.
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Liu et al. (2021) conducted a meta-analysis in Atrial fibrillation and cancer (n=248,218). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Stroke or systemic embolism (SSE) (RR 0.66, 95% CI 0.54-0.80). Compared with vitamin K antagonists, direct oral anticoagulants significantly reduced the risk of stroke or systemic embolism by 34% (RR 0.66) in patients with atrial fibrillation and cancer.
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