DOACs reduced all-cause death by 41%, major bleeding by 25%, intracranial bleeding by 64%, and stroke/systemic embolism by 34% versus VKAs in AF with HCM.
Do direct oral anticoagulants reduce thromboembolic events and bleeding compared to vitamin K antagonists in patients with atrial fibrillation and hypertrophic cardiomyopathy?
DOACs demonstrate a superior efficacy and safety profile compared to VKAs in patients with atrial fibrillation and hypertrophic cardiomyopathy, significantly reducing mortality, stroke, and major bleeding.
Abstract Background Vitamin K antagonists (VKAs) are the standard anticoagulation therapy for atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) to prevent thromboembolic events; however, they require frequent monitoring and dietary restrictions. Direct oral anticoagulants (DOACs) offer a more predictable pharmacokinetic profile and fewer drug interactions, but their efficacy and safety in HCM patients with AF remain unclear due to limited and conflicting evidence. Purpose This systematic review and meta-analysis aimed to compare the efficacy and safety of DOACs and VKAs in patients with atrial fibrillation and hypertrophic cardiomyopathy. Methods A systematic search of PubMed, EMBASE, and Cochrane Library databases was conducted for randomised controlled trials (RCTs) and observational studies comparing the use of DOACs and VKAs in patients with atrial fibrillation and hypertrophic cardiomyopathy. Eligible studies reported outcomes such as all-cause death, major bleeding, gastrointestinal (GI) bleeding, intracranial bleeding, and stroke/systemic embolism. The results were expressed as Hazard Ratio (HR) and Risk Ratio (RR), with 95% confidence intervals (CI), using a random-effects model. All statistical analyses were performed using R (version 4.4.2). Results Our meta-analysis included two RCTs and nine observational studies involving 15,558 patients. DOAC therapy was superior to VKA therapy in reducing the incidences of all-cause death HR 0.59; 95% CI (0.42–0.82); p=0.002, major bleeding HR 0.7485; 95% CI (0.57–0.96); p=0.02, intracranial bleeding HR 0.36; 95% CI (0.22–0.57); p0.001, and stroke/systemic embolism HR 0.66; 95% CI (0.52–0.85); p=0.001. Compared to the VKA group, the DOAC group had a similar outcome in the incidence of GI bleeding RR 0.59; 95% CI (0.26–1.38); p=0.22. Conclusion These results suggest that DOACs may provide a more favourable benefit-risk profile for patients with atrial fibrillation and hypertrophic cardiomyopathy, particularly in reducing severe bleeding events and thromboembolic complications. Further RCT research is needed to confirm these findings and explore long-term outcomes in this population.
Chagas et al. (2025) studied this question. DOACs reduced all-cause death by 41%, major bleeding by 25%, intracranial bleeding by 64%, and stroke/systemic embolism by 34% versus VKAs in AF with HCM.