Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Cancer in Real World: Meta-Analysis of Retrospective Observational Studies
DOI: 10.23977/medsc.2021.020112 | Downloads: 7 | Views: 834
Author(s)
Bo Cao 1, Xiaobo Hu 1, Min Chen 2, Mingfeng Shen 1, Lan Xu 1
Affiliation(s)
1 Department of Clinical Pharmacy, Affiliated Ninth Hospital of Suzhou University, Suzhou, China
2 Department of Cardiovascular Medicine, Affiliated Ninth Hospital of Suzhou University, Suzhou, China
Corresponding Author
Lan XuABSTRACT
Background: Evidence on the safety and effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer is rather limited, so we performed this meta-analysis to compare the efficacy and safety of NOACs with vitamin K antagonists (VKAs) in real-world patients with AF and cancer. Methods: The PubMed and Embase databases were searched up to June 2020 for eligible studies. Outputs were presented as risk ratios (RRs) and corresponding 95% confidence intervals (CIs) using a random-effects model. Results: A total of five observational studies involving 232,234 cancer patients with AF were included. Compared with VKAs, use of NOACs was associated with decreased risks of stroke or systemic embolism (RR, 0.79; 95% CI 0.69-0.90), is chaemic stroke (RR, 0.82; 95% CI, 0.72-0.93), venous thromboembolism (VTE) (RR, 0.28; 95% CI 0.14-0.53), all-cause death (RR, 0.57; 95% CI 0.50-0.64), major bleeding (RR, 0.60; 95% CI 0.51-0.72) and intracranial or gastrointestinal bleeding (RR, 0.61; 95% CI, 0.51-0.73). Conclusions: In this combined analysis of real-world observational studies, NOACs showed lower risks of stroke or systemic embolism, ischaemic stroke, VTE, all-cause death and reduced rates of major bleeding and intracranial or gastrointestinal bleeding compared to VKAs in patients with AF and cancer.
KEYWORDS
Atrial fibrillation, Cancer, Oral anticoagulants, Real-world, Meta-analysisCITE THIS PAPER
Bo Cao, Xiaobo Hu, Min Chen, Mingfeng Shen, Lan Xu. Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Cancer in Real World: Meta-Analysis of Retrospective Observational Studies. MEDS Clinical Medicine (2021) 2: 61-66. DOI: http://dx.doi.org/10.23977/medsc.2021.020112.
REFERENCES
[1] Wang TJ, Massaro JM, Levy D, et al. A risk score for predicting stroke or death
[2] in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. J Am Med Assoc 2003; 290: 1049–1056.
[3] O'Neal WT, Lakoski SG, Qureshi W, et al. Relation between cancer and atrial fibrillation (from the REasons for Geographic and Racial Differences in Stroke Study). Am J Cardiol 2015;115:1090-4.
[4] Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712-1723.
[5] Chu G, Versteeg HH, Verschoor AJ, Trines SA, Hemels MEW, Ay C, et al. Atrial
[6] fibrillation and cancer – An unexplored field in cardiovascular oncology. Blood Rev 2019; 35: 59–67.
[7] Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. Lancet 2014; 383: 955–62.
[8] Yang, P., Zhu, D., Xu, X., Shen, W., Wang, C., Jiang, Y., ... & Wu, Q. (2019). Efficacy and safety of oral anticoagulants in atrial fibrillation patients with cancer-a network meta-analysis. Heart failure reviews, 1-9.
[9] Cavallari, I., Verolino, G., Romano, S., & Patti, G. (2020). Efficacy and safety of nonvitamin K oral anticoagulants in patients with atrial fibrillation and cancer: a study-level meta-analysis. Thrombosis and haemostasis, 120(02), 314-321.
[10] Deng, Y., Tong, Y., Deng, Y., Zou, L., Li, S., & Chen, H. (2019). Non–Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Cancer and Atrial Fibrillation: A Systematic Review and Meta‐Analysis. Journal of the American Heart Association, 8(14), e012540.
[11] Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting: Meta-analysis Of Observational Studies
[12] in Epidemiology (MOOSE) group. J Am Med Assoc 2000; 283: 2008–2012.
[13] Kim, K., Lee, Y. J., Kim, T. H., Uhm, J. S., Pak, H. N., Lee, M. H., & Joung, B. (2018). Effect of non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients with newly diagnosed cancer. Korean Circulation Journal, 48(5), 406-417.
[14] Ording, A. G., Horváth‐Puhó, E., Adelborg, K., Pedersen, L., Prandoni, P., & Sørensen, H. T. (2017). Thromboembolic and bleeding complications during oral anticoagulation therapy in cancer patients with atrial fibrillation: a Danish nationwide population‐based cohort study. Cancer medicine, 6(6), 1165-1172.
[15] Sawant, A. C., Kumar, A., Mccray, W., Tetewsky, S., Parone, L., Sridhara, S., ... & Bhardwaj, A. (2019). Superior safety of direct oral anticoagulants compared to Warfarin in patients with atrial fibrillation and underlying cancer: a national veterans affairs database study. Journal of Geriatric Cardiology: JGC, 16(9), 706.
[16] Shah, S., Norby, F. L., Datta, Y. H., Lutsey, P. L., MacLehose, R. F., Chen, L. Y., & Alonso, A. (2018). Comparative effectiveness of direct oral anticoagulants and warfarin in patients with cancer and atrial fibrillation. Blood advances, 2(3), 200-209.
[17] Yasui, T., Shioyama, W., Oboshi, M., Oka, T., & Fujita, M. (2019). Oral anticoagulants in Japanese patients with atrial fibrillation and active cancer. Internal Medicine, 58(13), 1845-1849.
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