Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
J Thromb Thrombolysis. 2021 Feb;51(2):419-429. doi: 10.1007/s11239-020-02304-3. Epub 2020 Oct 12.
Direct oral anticoagulants (DOACs) are recommended as first-line anticoagulants in patients with atrial fibrillation (AF). However, in patients with cancer and AF the efficacy and safety of DOACs are not well established.
We performed a meta-analysis comparing available data regarding the efficacy and safety of DOACs vs vitamin K antagonists (VKAs) in cancer patients with non-valvular AF.
An online search of Pubmed and EMBASE libraries (from inception to May, 1 2020) was performed, in addition to manual screening. Nine studies were considered eligible for the meta-analysis involving 46,424 DOACs users and 182,797 VKA users.
The use of DOACs was associated with reduced risks of systemic embolism or any stroke (RR 0.65; 95% CI 0.52-0.81; p 0.001), ischemic stroke (RR 0.84; 95% CI 0.74-0.95; p 0.007) and hemorrhagic stroke (RR 0.61; 95% CI 0.52-0.71; p 0.00001) as compared to VKA group. DOAC use was associated with significantly reduced risks of major bleeding (RR 0.68; 95% CI 0.50-0.92; p 0.01) and intracranial or gastrointestinal bleeding (RR 0.64; 95% CI 0.47-0.88; p 0.006). Compared to VKA, DOACs provided a non-statistically significant risk reduction of the outcomes major bleeding or non-major clinically relevant bleeding (RR 0.94; 95% CI 0.78-1.13; p 0.50) and any bleeding (RR 0.91; 95% CI 0.78-1.06; p 0.24).
In comparison to VKA, DOACs were associated with a significant reduction of the rates of thromboembolic events and major bleeding complications in patients with AF and cancer. Further studies are needed to confirm our results.
直接口服抗凝剂（DOACs）被推荐作为房颤（AF）患者的一线抗凝药物。然而，在患有癌症和 AF 的患者中，DOACs 的疗效和安全性尚未得到充分证实。
我们进行了一项荟萃分析，比较了 DOACs 与维生素 K 拮抗剂（VKAs）在非瓣膜性 AF 合并癌症患者中的疗效和安全性的现有数据。
在线检索 Pubmed 和 EMBASE 数据库（从成立到 2020 年 5 月 1 日），并进行手动筛选。有 9 项研究符合荟萃分析的条件，共纳入 46424 例 DOACs 使用者和 182797 例 VKA 使用者。
与 VKA 组相比，DOACs 组的全身性栓塞或任何卒中（RR 0.65；95%CI 0.52-0.81；p<0.001）、缺血性卒中（RR 0.84；95%CI 0.74-0.95；p=0.007）和出血性卒中（RR 0.61；95%CI 0.52-0.71；p<0.00001）的风险降低。DOACs 组大出血（RR 0.68；95%CI 0.50-0.92；p=0.01）和颅内或胃肠道出血（RR 0.64；95%CI 0.47-0.88；p=0.006）的风险显著降低。与 VKA 相比，DOACs 组在主要出血或非主要临床相关出血（RR 0.94；95%CI 0.78-1.13；p=0.50）和任何出血（RR 0.91；95%CI 0.78-1.06；p=0.24）的结局风险降低方面无统计学意义。
与 VKA 相比，DOACs 可显著降低 AF 合并癌症患者血栓栓塞事件和大出血并发症的发生率。需要进一步的研究来证实我们的结果。
