Key result
Direct oral anticoagulants reduced thrombotic events by 50% (RR 0.50) compared to vitamin K antagonists in patients with cardiac amyloidosis and atrial fibrillation, with no significant difference in bleeding.
Why the study?
Atrial fibrillation is common in patients with cardiac amyloidosis, but the optimal anticoagulation strategy to prevent thromboembolic events in this population is unknown.
Do direct oral anticoagulants reduce thrombotic events and major bleeding compared to vitamin K antagonists in patients with cardiac amyloidosis and atrial fibrillation?
Meta-Analysis (n=1,579)
Do direct oral anticoagulants reduce thrombotic events and major bleeding compared to vitamin K antagonists in patients with cardiac amyloidosis and atrial fibrillation?
In patients with cardiac amyloidosis and atrial fibrillation, DOACs are associated with a significantly lower risk of thrombotic events and a similar risk of major bleeding compared to vitamin K antagonists.
Answers are grounded in this paper and cite their sources.
DOACs may be preferred over VKAs in cardiac amyloidosis with AF; extends thrombotic benefit data to this high-risk population.
Background and Objectives: Atrial fibrillation is common in patients with cardiac amyloidosis. However, the optimal anticoagulation strategy to prevent thromboembolic events in patients with cardiac amyloidosis and atrial fibrillation is unknown. This systematic review and meta-analysis compares direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in patients with cardiac amyloidosis and atrial fibrillation. Methods: We performed a systematic literature review to identify clinical studies of anticoagulation therapies for patients with cardiac amyloidosis and atrial fibrillation. The primary outcomes of major bleeding and thrombotic events were reported using random effects risk ratios (RRs) with 95% confidence interval (CI). Results: Our search yielded 97 potential studies and evaluated 14 full-text articles based on title and abstract. We excluded 10 studies that were review articles or did not compare anticoagulation. We included 4 studies reporting on 1,579 patients. The pooled estimates are likely underpowered due to small sample sizes. There was no difference in bleeding events for patients with cardiac amyloidosis and atrial fibrillation treated with DOACs compared to VKAs with a RR of 0.64 (95% CI, 0.38-1.10; p=0.10). There were decreased thrombotic events for patients with cardiac amyloidosis and atrial fibrillation treated with DOACs compared to VKAs with a RR of 0.50 (95% CI, 0.32-0.79; p=0.003). Conclusions: This systematic review and meta-analysis suggests that DOACs are as safe and effective as VKAs in patients with cardiac amyloidosis and atrial fibrillation. However, more data are needed to investigate clinical differences in anticoagulation therapy in this patient population.
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Lacy et al. (2023) conducted a meta-analysis in Cardiac amyloidosis and atrial fibrillation (n=1,579). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Thrombotic events (RR 0.50, 95% CI 0.32-0.79, p=0.003). Direct oral anticoagulants reduced thrombotic events by 50% (RR 0.50) compared to vitamin K antagonists in patients with cardiac amyloidosis and atrial fibrillation, with no significant difference in bleeding.
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