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Review
. 2024 Jan 2;22(1):2.
doi: 10.1186/s12959-023-00562-8.

The efficacy and safety of direct oral anticoagulants compared with vitamin K antagonist in patients with hypertrophic cardiomyopathy and atrial fibrillation

Si-Qi Lyu  1 , Jun Zhu  1 , Juan Wang  1 , Shuang Wu  1 , Han Zhang  1 , Xing-Hui Shao  1 , Yan-Min Yang  2
Affiliations
Review

The efficacy and safety of direct oral anticoagulants compared with vitamin K antagonist in patients with hypertrophic cardiomyopathy and atrial fibrillation

Si-Qi Lyu et al. Thromb J. .

Abstract

Background: The benefit-risk profile of direct oral anticoagulants (DOAC) therapy in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) has not been well established yet. This study aimed to evaluate the efficacy and safety of DOAC compared with vitamin K antagonists (VKA) in patients with HCM and AF.

Methods: PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing DOAC with VKA in patients with HCM and AF. The primary endpoint was thromboembolic events. The relative risks and standard errors were pooled by random-effect models using the generic inverse variance method.

Results: Seven observational studies involving 9395 patients were included in this meta-analysis. Compared to the VKA group, the DOAC group displayed a similar risk of thromboembolic events [RR (95%CI): 0.93 (0.73-1.20), p = 0.59] and ischemic stroke [RR (95%CI): 0.65 (0.33-1.28), p = 0.22]. The incidence of major bleeding was comparable between the two groups [RR (95%CI): 0.75 (0.49-1.15), p = 0.19]. Meanwhile, DOAC therapy was superior to VKA therapy in reducing the incidences of all-cause death [RR (95%CI): 0.44 (0.35-0.55), p < 0.001], cardiovascular death [RR (95%CI): 0.41 (0.22-0.75), p = 0.004], and intracranial hemorrhage [RR (95%CI): 0.42 (0.24-0.74), p = 0.003].

Conclusion: In patients with HCM and AF, DOAC therapy was similar to VKA therapy in reducing the risk of thromboembolic events, without increasing bleeding risk. In addition, the DOAC group displayed significant advantages in reducing mortality and intracranial hemorrhage compared with the VKA group. Further randomized controlled trials are needed to provide more evidence for DOAC therapy in this population.

Keywords: Atrial fibrillation; Direct oral anticoagulants; Hypertrophic cardiomyopathy; Meta-analysis; Vitamin K antagonists.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection process
Fig. 2
Fig. 2
Efficacy endpoints in the DOAC group compared with the VKA group. Abbreviation: DOAC direct oral anticoagulants, VKA vitamin K antagonists
Fig. 3
Fig. 3
Safety endpoints in the DOAC group compared with the VKA group. Abbreviation: DOAC direct oral anticoagulants, VKA vitamin K antagonists
Fig. 4
Fig. 4
Begg’s funnel plot of publication bias in a selection of studies on the rates of thromboembolic events between DOAC and VKA therapy. Abbreviation: DOAC direct oral anticoagulants, VKA vitamin K antagonists, log (RR): natural logarithm of RR; S.E: standard error. The horizontal line means the magnitude of the effect
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