Key result
DOACs and warfarin effectively reduce stroke risk with comparable safety in HCM patients with AF.
Why the study?
Anticoagulation strategies are inconsistently applied in hypertrophic cardiomyopathy, particularly in patients without documented atrial fibrillation but with other risk factors.
Does anticoagulation (warfarin or DOACs) reduce stroke risk in patients with hypertrophic cardiomyopathy?
Systematic Review (n=90,661)
Does anticoagulation (warfarin or DOACs) reduce stroke risk in patients with hypertrophic cardiomyopathy?
In patients with hypertrophic cardiomyopathy, atrial fibrillation is common and significantly increases stroke risk, which can be effectively mitigated by both warfarin and DOACs with comparable safety.
May support anticoagulation with either agent in HCM with AF; leaves open need for RCTs to confirm comparative efficacy.
Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by myocardial hypertrophy, diastolic dysfunction, and a high risk of atrial fibrillation (AF) and stroke. AF is the most common arrhythmia in HCM and a key driver of cardioembolic events. However, anticoagulation strategies are inconsistently applied, especially in patients without documented AF but with other risk factors such as left atrial enlargement. This systematic review, conducted according to PRISMA guidelines, analyzed observational and case–control studies published from 2000 to 2023 in PubMed, Embase, Scopus, and Web of Science. Fifteen studies including 90,661 HCM patients were evaluated. AF prevalence ranged from 10 to 45.1%, and stroke incidence from 0.5 to 22.4%, with annualized rates of 0.5–1.78%. Risk factors for stroke included advanced age, prior TIA/stroke, heart failure, and left atrial enlargement. Both warfarin and direct oral anticoagulants (DOACs) effectively reduced stroke risk with comparable safety profiles. AF markedly increases stroke risk in HCM, underscoring the need for individualized anticoagulation strategies. Risk stratification incorporating CHA2DS2-VASc score, left atrial size, and clinical characteristics is essential for optimizing prevention and management.
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Ochani et al. (2026) conducted a systematic review in Hypertrophic cardiomyopathy (n=90,661). Anticoagulation (warfarin or direct oral anticoagulants) vs. No anticoagulation or alternative anticoagulants was evaluated on Thromboembolic events (ischemic stroke, embolic stroke, systemic embolism). In patients with hypertrophic cardiomyopathy, atrial fibrillation markedly increases stroke risk, and both warfarin and direct oral anticoagulants effectively reduce stroke risk with comparable safety profiles.
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