Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta-analysis
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Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta‑analysis Marco Valerio Mariani1 · Michele Magnocavallo1 · Martina Straito1 · Agostino Piro1 · Paolo Severino1 · Gino Iannucci2 · Cristina Chimenti1 · Massimo Mancone1 · Domenico Giovanni Della Rocca3 · Giovanni Battista Forleo4 · Francesco Fedele1 · Carlo Lavalle1 Accepted: 30 September 2020 © The Author(s) 2020
Abstract Background Direct oral anticoagulants (DOACs) are recommended as first-line anticoagulants in patients with atrial fibrillation (AF). However, in patients with cancer and AF the efficacy and safety of DOACs are not well established. Objective We performed a meta-analysis comparing available data regarding the efficacy and safety of DOACs vs vitamin K antagonists (VKAs) in cancer patients with non-valvular AF. Methods An online search of Pubmed and EMBASE libraries (from inception to May, 1 2020) was performed, in addition to manual screening. Nine studies were considered eligible for the meta-analysis involving 46,424 DOACs users and 182,797 VKA users. Results The use of DOACs was associated with reduced risks of systemic embolism or any stroke (RR 0.65; 95% CI 0.52– 0.81; p 0.001), ischemic stroke (RR 0.84; 95% CI 0.74–0.95; p 0.007) and hemorrhagic stroke (RR 0.61; 95% CI 0.52–0.71; p 0.00001) as compared to VKA group. DOAC use was associated with significantly reduced risks of major bleeding (RR 0.68; 95% CI 0.50–0.92; p 0.01) and intracranial or gastrointestinal bleeding (RR 0.64; 95% CI 0.47–0.88; p 0.006). Compared to VKA, DOACs provided a non-statistically significant risk reduction of the outcomes major bleeding or non-major clinically relevant bleeding (RR 0.94; 95% CI 0.78–1.13; p 0.50) and any bleeding (RR 0.91; 95% CI 0.78–1.06; p 0.24). Conclusions In comparison to VKA, DOACs were associated with a significant reduction of the rates of thromboembolic events and major bleeding complications in patients with AF and cancer. Further studies are needed to confirm our results. Keywords Atrial fibrillation · Cancer · Direct oral anticoagulants · Vitamin K antagonists
Highlights • Anticoagulation in patients with atrial fibrillation and
malignances is challenging due to cancer-related factors.
• The efficacy and safety of direct oral anticoagulants in
cancer patients is not well established. In our meta-analysis the use of direct oral anticoagulants was associated with reduced risk of ischemic and hemorragic stroke,
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02304-3) contains supplementary material, which is available to authorized users. * Marco Valerio Mariani [email protected] Extended author information available on the last page of the article
major bleedings and intracranial and gastrointestinal bleedings in comparison to vitamin K antagonists. • Direct oral anticoagulants use was related to more effective and safer profile as compared to vitamin K antagonists and may represent a suitable a
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