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Effectiveness and safety of direct oral anticoagulants versus vitamin k antagonists in patients with atrial fibrillation and hypertrophic cardiomyopathy: a systematic review and meta-analysis
10.1093/eurheartj/ehaf784.4272
2025-11-05
0
PRE
AI
Abstract
En 中文
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Purpose</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>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).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>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); p&lt;0.001], 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].</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>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. </jats:p>
</jats:sec>
Keywords:
Direct oral anticoagulants
Vitamin K antagonists
Atrial fibrillation
Hypertrophic cardiomyopathy
Meta-analysis
Journal
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35.6
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federal district military firefighter brigade
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2
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unifebe
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unidavi
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30
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redentor afya university
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federal university of minas gerais
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915
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hospital espirita andre luiz
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