Safety and efficacy of new oral anticoagulants compared to those of warfarin in AF patients with cancer: a meta-analysis of randomized clinical trials and observational studies

Chen, Yueming; Mao, Min; Chang, Jing; Yan, Ji; Yang, Tiantian; Liu, Yang; Luo, Meng; Hu, Yunxia; Yang, Qi; Zhou, Lin; Kang-hua, MA

doi:10.1007/s00228-021-03132-x

Cited by 8 publications

(6 citation statements)

References 43 publications

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“…Casula et al (37) performed a meta-analysis by including three post-hoc analyses of RCTs (12)(13)(14), suggesting that direct oral Xa inhibitors (rivaroxaban, apixaban, edoxaban) had similar effects but were safer compared with warfarin in patients with cancer and AF. In addition to post-hoc analyses of RCTs, the meta-analyses by Chen et al (38) and Mariani et al (39) also included the different number of observational studies. By comparison, the largest number of studies (four post-hoc analyses of RCTs and nine observational cohorts) were included in our current meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of DOACs vs. VKAs in AF Patients With Cancer: Evidence From Randomized Clinical Trials and Observational Studies

Liu

Luo

et al. 2021

Front. Cardiovasc. Med.

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Background: The use of direct oral anticoagulants (DOACs) is recommended as the preferred treatment drug in patients with nonvalvular atrial fibrillation (AF). However, the effectiveness and safety of DOACs compared with vitamin K antagonists (VKAs) in patients with cancer and AF are still controversial. Therefore, we performed a meta-analysis regarding the effectiveness and safety of DOACs vs. VKAs in AF patients with cancer.Methods: A search of the Pubmed and EMBASE databases until August 2021 was performed. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model with an inverse variance method.Results: Thirteen studies were deemed to meet the criteria. For the effectiveness outcomes, the use of DOACs compared with VKAs use was significantly associated with decreased risks of stroke or systemic embolism (RR = 0.66, 95% CI: 0.54–0.80) and venous thromboembolism (RR = 0.40, 95% CI: 0.26–0.61), but not ischemic stroke (RR = 0.79, 95% CI: 0.56–1.11), myocardial infarction (RR = 0.78, 95% CI: 0.56–1.11), cardiovascular death (RR = 0.76, 95% CI: 0.53–1.09), and all-cause death (RR = 0.82, 95% CI: 0.43–1.56). For the safety outcomes, compared with VKAs use, the use of DOACs was associated with reduced risks of intracranial bleeding (RR = 0.60, 95% CI: 0.50–0.71) and gastrointestinal bleeding (RR = 0.87, 95% CI: 0.80–0.95). There were no significant differences in major bleeding (RR = 0.87, 95% CI: 0.74–1.04), major or nonmajor clinically relevant bleeding (RR = 0.87, 95% CI: 0.74–1.01), and any bleeding (RR = 0.88, 95% CI: 0.76–1.03).Conclusion: Compared with VKAs, DOACs appeared to have significant reductions in stroke or systemic embolism, venous thromboembolism, intracranial bleeding, and gastrointestinal bleeding, but comparable risks of ischemic stroke, myocardial infarction, cardiovascular death, all-cause death, major bleeding, major or nonmajor clinically relevant bleeding, and any bleeding in patients with AF and cancer.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of DOACs vs. VKAs in AF Patients With Cancer: Evidence From Randomized Clinical Trials and Observational Studies

Liu

Luo

et al. 2021

Front. Cardiovasc. Med.

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“…The use of oral anticoagulants is associated with a lower risk of mortality in patients with atrial fibrillation ( 36 ). It has been demonstrated that the patients who have concomitant cancer and atrial fibrillation can be benefited from anticoagulation with nonvitamin K antagonist oral anticoagulants (also known as direct oral anticoagulants (DOACs)) as well as warfarin ( 47 ). However, DOACs have a safer profile and greater effectiveness as compared to vitamin K antagonists (VKAs) ( 48 ).…”

Section: Discussionmentioning

confidence: 99%

Higher Mortality Associated With New-Onset Atrial Fibrillation in Cancer Patients: A Systematic Review and Meta-Analysis

Murtaza

Baig

Ahmed

et al. 2022

Front. Cardiovasc. Med.

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AimThis research was conducted to evaluate the mortality outcome of cancer patients with new-onset atrial fibrillation. We also aimed to assess if there was any confounding relation between the mortality of these patients and surgical intervention.Materials and MethodsA systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 7 February 2022. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. Only those studies that involved cancer patients without pre-existing atrial fibrillation were selected, and mortality rate was compared between the patients who developed atrial fibrillation and those who did not. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the odds ratio (OR) and the corresponding 95% confidence interval (CI).ResultsEighteen studies were selected for meta-analysis. Statistical analysis showed that the cancer patients who subsequently developed atrial fibrillation had a significantly higher mortality rate as compared to those who did not (OR = 1.90 [1.65, 2.19]; p < 0.00001; I2 = 100%). We also separately analyzed the mortality risk in the surgery group and the non-surgery group. Statistical analysis showed that there was significantly higher mortality rate associated with new-onset atrial fibrillation in cancer patients in the surgery group (OR= 3.68 [2.29, 5.94]; p < 0.00001; I2 = 61%) as well as in the non-surgery group (OR = 1.64 [1.39, 1.93]; p < 0.00001; I2 = 100%).ConclusionCancer patients, who subsequently developed atrial fibrillation, had a higher mortality rate as compared to those cancer patients who did not develop atrial fibrillation. A higher mortality rate was seen in both surgical and non-surgical subgroups. This implies that extra care and specific measures must be taken in the management of cancer patients with new-onset atrial fibrillation.

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“…Usually, these agents are not ulcerogenic and produce AUGIB from minor pre-existing lesions like angiodysplasias. Also patients with undiagnosed cancers and/or polyps are at increased risks of acute bleeding [ 30 ]. Augustson et al in a recent study found that oral anticoagulant users were more likely to bleed from polyps, mucosal erosions and angiodysplasias compared to those not on oral anticoagulants [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Upper Gastrointestinal Bleeding: Less Severe Bleeding in More Frail and Older Patients, Comparison Between Two Time Periods Fifteen Years Apart

et al. 2022

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Background: Acute upper gastrointestinal bleeding (AUGIB) remains a common medical emergency with considerable morbidity and mortality. The aim of this study was to describe the patient characteristics, diagnoses and clinical outcomes of patients presenting with AUGIB nowadays and compare these with those of patients 15 years ago. Methods:This was a single-center survey of adults (> 16 years) presenting with AUGIB to a tertiary hospital. Data from 401 patients

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Safety and efficacy of new oral anticoagulants compared to those of warfarin in AF patients with cancer: a meta-analysis of randomized clinical trials and observational studies

Cited by 8 publications

References 43 publications

Effectiveness and Safety of DOACs vs. VKAs in AF Patients With Cancer: Evidence From Randomized Clinical Trials and Observational Studies

Effectiveness and Safety of DOACs vs. VKAs in AF Patients With Cancer: Evidence From Randomized Clinical Trials and Observational Studies

Higher Mortality Associated With New-Onset Atrial Fibrillation in Cancer Patients: A Systematic Review and Meta-Analysis

Acute Upper Gastrointestinal Bleeding: Less Severe Bleeding in More Frail and Older Patients, Comparison Between Two Time Periods Fifteen Years Apart

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