Nong Qinling, Liang Shucheng, Zhu Wengen, Chen Yili, Zhang Tang
Department of Cardiology, Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine, 530000 Nanning, Guangxi, China.
Faculty of Medicine, Macau University of Science and Technology, 999078 Macau SAR, China.
Rev Cardiovasc Med. 2025 Mar 13;26(3):26948. doi: 10.31083/RCM26948. eCollection 2025 Mar.
This study aimed to systematically review and synthesize evidence comparing direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) for anticoagulation in patients with atrial fibrillation (AF) and cardiac amyloidosis (CA).
A comprehensive search of PubMed and EMBASE databases was conducted through January 2024 to identify studies comparing DOACs and VKAs in AF patients with CA. Eligible studies underwent rigorous screening and data extraction to evaluate safety and efficacy outcomes.
Four studies met the criteria. The first study reported similar embolic event rates between DOACs (3.9%) and VKAs (2.9%) per 100 patient years, while major bleeding rates were 5.21% and 3.74%, respectively. The second paper found stroke rates of 2% for DOACs and 4% for VKAs, with bleeding complications observed in 10% of DOAC patients compared to 20% in VKA patients. The third cohort demonstrated that DOACs were associated with significantly lower risks of stroke and major bleeding compared to VKAs. The last study reported embolic event rates of 1.6 and 2.0 per 100 patient years for DOACs and VKAs, respectively. In the pooled analysis, DOACs were associated with a reduced risk of thromboembolic events (odds ratio [OR] = 0.52; 95% confidence interval [CI]: 0.32-0.84), and no difference in major bleeding between the two groups (OR = 0.61, 95% CI: 0.25-1.51).
Existing studies support the use of DOACs as a non-inferior therapeutic option compared to VKAs for preventing thromboembolism in patients with AF and cardiac amyloidosis. DOACs may also offer practical advantages, including reduced bleeding risks and ease of management, but further high-quality randomized controlled trials are needed to confirm these findings and guide clinical practice.
本研究旨在系统回顾和综合比较直接口服抗凝剂（DOACs）与维生素K拮抗剂（VKAs）用于心房颤动（AF）合并心脏淀粉样变性（CA）患者抗凝治疗的证据。
截至2024年1月，对PubMed和EMBASE数据库进行全面检索，以识别比较DOACs和VKAs在AF合并CA患者中的研究。符合条件的研究经过严格筛选和数据提取，以评估安全性和有效性结果。
四项研究符合标准。第一项研究报告，每100患者年DOACs组的栓塞事件发生率为3.9%，VKAs组为2.9%，而大出血发生率分别为5.21%和3.74%。第二篇论文发现DOACs组的卒中发生率为2%，VKAs组为4%，DOACs组10%的患者出现出血并发症，而VKAs组为20%。第三项队列研究表明，与VKAs相比，DOACs发生卒中和大出血的风险显著更低。最后一项研究报告，DOACs和VKAs每100患者年的栓塞事件发生率分别为1.6和2.0。在汇总分析中，DOACs与血栓栓塞事件风险降低相关（优势比[OR]=0.52；95%置信区间[CI]：0.32-0.84），两组大出血无差异（OR=0.61，95%CI：0.25-1.51）。
现有研究支持DOACs作为一种与VKAs相比在预防AF合并心脏淀粉样变性患者血栓栓塞方面非劣效的治疗选择。DOACs还可能具有实际优势，包括降低出血风险和易于管理，但需要进一步的高质量随机对照试验来证实这些发现并指导临床实践。
