Lozier Matthew R, Sanchez Alexandra M, Lee John J, Donath Elie M, Font Vicente E, Escolar Esteban
University of Miami at Holy Cross Hospital, Division of Internal Medicine, Fort Lauderdale, FL, USA.
Columbia University at Mount Sinai Medical Center, Division of Cardiology, Miami Beach, FL, USA.
J Atr Fibrillation. 2019 Dec 31;12(4):2207. doi: 10.4022/jafib.2207. eCollection 2019 Dec.
Limited data is available assessing the efficacy and safety of different anticoagulation (AC) strategies for prevention of thromboembolic events, major bleeding, and all-cause mortality in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). In this systematic review, we conducted a literature search to examine the possible association between different AC strategies and prevention of these adverse outcomes.
Scientific databases (PubMed, EMBASE, and Scopus) were searched using relevant medical subject headings and keywords to retrieve studies published through September of 2019. Studies assessing the outcomes of interest in patients with HCM and AF receiving AC, no AC as well as direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) were selected.
This review identified 14 observational studies evaluating thromboembolic events by AC strategies in 8,479 participants with concomitant HCM and AF. The use of AC was associated with a lower pooled incidence rate of total thromboembolic events at 9.5% (112 events in 1,175 patients) compared to 22.1% with no AC (108 events in 489 patients). In addition, the use of DOACs was associated with a lower pooled incidence rate of thromboembolic events at 4.7% (169 events in 3,576 patients) compared to 8.7% with VKAs (281 events in 3,239 patients). Furthermore, the use of DOACs compared to VKAs was associated with a lower pooled incidence rate of major bleeding and all-cause mortality at 3.8% (136 events in 3,576 patients) versus 6.8% (220 events in 3,239 patients) and 4.1% (124 events in 3,008 patients) versus 16.1% (384 events in 2,380 patients), respectively.
AC of patients with concomitant HCM and AF was associated with a lower incidence of thromboembolic events when compared to antiplatelet therapy or no treatment. Treatment with DOACs was also associated with a lower incidence of thromboembolic events, major bleeding, and all-cause mortality when compared to VKAs.
关于不同抗凝（AC）策略预防肥厚型心肌病（HCM）合并心房颤动（AF）患者血栓栓塞事件、大出血及全因死亡率的疗效和安全性的评估数据有限。在本系统评价中，我们进行了文献检索，以研究不同AC策略与预防这些不良结局之间的可能关联。
使用相关医学主题词和关键词检索科学数据库（PubMed、EMBASE和Scopus），以获取截至2019年9月发表的研究。选取评估HCM合并AF患者接受AC、不接受AC以及直接口服抗凝剂（DOACs）和维生素K拮抗剂（VKAs）的相关结局的研究。
本评价纳入了14项观察性研究，共8479例HCM合并AF患者，评估了AC策略对血栓栓塞事件的影响。与未接受AC治疗（489例患者中有108例事件，发生率22.1%）相比，接受AC治疗的患者总血栓栓塞事件合并发生率较低，为9.5%（1175例患者中有112例事件）。此外，与使用VKAs（3239例患者中有281例事件，发生率8.7%）相比，使用DOACs的患者血栓栓塞事件合并发生率较低，为4.7%（3576例患者中有169例事件）。此外，与VKAs相比，使用DOACs的患者大出血和全因死亡率合并发生率也较低，分别为3.8%（3576例患者中有136例事件）对6.8%（3239例患者中有220例事件），以及4.1%（3008例患者中有124例事件）对16.1%（2380例患者中有384例事件）。
与抗血小板治疗或不治疗相比，HCM合并AF患者接受AC治疗与较低的血栓栓塞事件发生率相关。与VKAs相比，使用DOACs治疗也与较低的血栓栓塞事件、大出血和全因死亡率相关。
