Superiority of Direct Oral Anticoagulants over Vitamin K Antagonists in Oncological Patients with Atrial Fibrillation: Analysis of Efficacy and Safety Outcomes

I. Parrini*, F. Luca, C.M. Rao, G. Parise, L.R. Micali, G. Musumeci, M. La Meir, F. Colivicchi, M.M. Gulizia, S. Gelsomino

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background and aim. Cancer and atrial fibrillation (AF) may be associated, and anticoagulation, either with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), is necessary to prevent thromboembolic events by reducing the risk of bleeding. The log incidence rate ratio (IRR) and 95% confidence interval were used as index statistics. Higgin's I-2 test was adopted to assess statistical inconsistencies by considering interstudy variations, defined by values ranging from 0 to 100%. I-2 values of less than 40% are associated with very low heterogeneity among the studies; values between 40% and 75% indicate moderate heterogeneity, and those greater than 75% suggest severe heterogeneity. The aim of this meta-analysis was to compare the safety and efficacy of VKAs and DOACs in oncologic patients with AF. Methods. A meta-analysis was conducted comparing VKAs to DOACs in terms of thromboembolic events and bleeding. A meta-regression was conducted to investigate the differences in efficacy and safety between four different DOACs. Moreover, a sub-analysis on active-cancer-only patients was conducted. Results. A total of eight papers were included. The log incidence rate ratio (IRR) for thromboembolic events between the two groups was -0.69 (p < 0.005). The meta-regression did not reveal significant differences between the types of DOACs (p > 0.9). The Log IRR was -0.38 (p = 0.008) for ischemic stroke, -0.43 (p = 0.02) for myocardial infarction, -0.39 (p = 0.45) for arterial embolism, and -1.04 (p = 0.003) for venous thromboembolism. The log IRR for bleeding events was -0.43 (p < 0.005), and the meta-regression revealed no statistical difference (p = 0.7). The log IRR of hemorrhagic stroke, major bleeding, and clinically relevant non-major bleeding between the VKA and DOAC groups was -0.51 (p < 0.0001), -0.45 (p = 0.03), and 0.0045 (p = 0.97), respectively. Similar results were found in active-cancer patients for all the endpoints except for clinically-relevant non-major bleedings. Conclusions. DOACs showed better efficacy and safety outcomes than VKAs. No difference was found between types of DOACs.
Original languageEnglish
Article number5712
Number of pages19
JournalJournal of Clinical Medicine
Volume11
Issue number19
DOIs
Publication statusPublished - 1 Oct 2022

Keywords

  • direct oral anticoagulants
  • warfarin
  • safety
  • efficacy
  • atrial fibrillation
  • cancer
  • CANCER-PATIENTS
  • WARFARIN
  • RISK
  • THROMBOEMBOLISM
  • COAGULATION
  • APIXABAN
  • INSIGHTS
  • HISTORY

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