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Non-vitamin K antagonist oral anticoagulants in patients with hypertrophic cardiomyopathy and atrial fibrillation: a systematic review and meta-analysis

  • Yunguo ZhouEmail author
  • Wenfeng He
  • Yue Zhou
  • Wengen ZhuEmail author
Article
  • 45 Downloads

Abstract

Several studies have explored the use of NOACs compared with vitamin K antagonists (VKAs) in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF); and therefore, we aimed to compare the efficacy and safety outcomes of NOACs with VKAs in this population. We systematically searched the PubMed and Embase databases until August 5, 2019 for studies that compared the effect of NOACs with VKAs in patients with HCM and AF. The risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. A total of four observational studies were included in this meta-analysis. Overall, compared with VKAs use, the use of NOACs was associated with reduced risks of ischemic stroke (RR 0.49, 95% CI 0.34–0.69), all-cause death (RR 0.44, 95% CI 0.35–0.55), and intracranial hemorrhage (RR 0.43, 95% CI 0.24–0.77). There were no differences in the risks of stroke or systemic embolism, major or clinically relevant bleeding, and gastrointestinal bleeding in patients with NOACs versus VKAs. Re-analyses with a fixed-effects model produced the similar results as the main analyses. For the efficacy and safety outcomes, comparisons of NOACs versus warfarin produced the similar results as those of NOACs versus VKAs. Based on current data from observational studies, compared with VKAs, NOACs had similar or lower risks of thromboembolic and bleeding events in patients with HCM and AF.

Keywords

Atrial fibrillation Hypertrophic cardiomyopathy Anticoagulants Efficacy Safety 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

11239_2019_2008_MOESM1_ESM.doc (1.1 mb)
Supplementary material 1 (DOC 1131 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatric Heart Disease Treatment Center, Jiangxi Provincial Children’s HospitalThe Affiliated Children’s Hospital of Nanchang UniversityNanchang of JiangxiChina
  2. 2.Jiangxi Key Laboratory of Molecular MedicineThe Second Affiliated Hospital of Nanchang UniversityNanchang of JiangxiChina
  3. 3.Department of Children’s OphthalmologyThe Second Affiliated Hospital of Nanchang UniversityNanchang of JiangxiChina
  4. 4.Department of CardiologyThe First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou of GuangdongChina

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