Real-world evidence of direct oral anticoagulants in patients with atrial fibrillation and cancer: A meta-analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS IJC Heart and Vasculature Pub Date : 2024-09-16 DOI:10.1016/j.ijcha.2024.101512

Xiuying Li , Runkai Li , Wengen Zhu , Dexi Wu

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Abstract

Background

Several observational cohort studies have been conducted to investigate the effectiveness and safety of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in patients who have both atrial fibrillation (AF) and cancer. Herein, we conducted a meta-analysis to present a comprehensive overview of the real-world evidence on DOACs in patients with AF and cancer.

Methods

A comprehensive search strategy was performed in PubMed and Embase until February 2024 for studies that enrolled AF patients with cancer who received DOACs or VKAs. The adjusted risk ratios (RRs) and 95% confidence intervals (CIs) of each outcome were extracted and pooled by a random-effects model.

Results

Seven observational cohort studies were eligible for data extraction. The random-effects model analysis indicated that compared with VKA use, the use of DOACs was significantly associated with reduced risks of stroke or systemic embolism (RR=0.79, 95 % CI 0.64–––0.97), major bleeding (RR=0.84, 95 % CI 0.71–––0.99), intracranial bleeding (RR=0.61, 95 % CI 0.54–––0.69), and gastrointestinal bleeding (RR=0.87, 95 % CI 0.80–––0.95) in AF patients with concurrent cancer.

Conclusions

Compared with VKAs, the use of DOACs was associated with decreased risks of thrombotic and bleeding events in AF patients with cancer. Data from real-world scenarios support the use of DOACs as a favorable treatment option for this specific patient population.

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心房颤动和癌症患者使用直接口服抗凝剂的现实证据：荟萃分析

背景已经开展了多项观察性队列研究，以调查直接口服抗凝剂（DOAC）与维生素 K 拮抗剂（VKAs）相比，对同时患有心房颤动（AF）和癌症的患者的有效性和安全性。在此，我们进行了一项荟萃分析，以全面概述有关 DOACs 用于房颤和癌症患者的实际证据。方法在 PubMed 和 Embase 中对 2024 年 2 月之前纳入接受 DOACs 或 VKAs 治疗的房颤和癌症患者的研究进行了全面检索。结果7项观察性队列研究符合数据提取条件。随机效应模型分析表明，与使用VKA相比，使用DOACs与卒中或全身性栓塞（RR=0.79，95 % CI 0.64--0.97）、大出血（RR=0.84，95 % CI 0.71--0.99）、颅内出血（RR=0.结论与VKA相比，使用DOACs可降低房颤合并癌症患者发生血栓和出血事件的风险。来自真实世界的数据支持将DOACs作为这一特殊患者群体的有利治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.