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Efficacy and safety of oral anticoagulants in atrial fibrillation patients with cancer—a network meta-analysis

Heart Failure Reviews volume 25, pages 823–831 (2020)Cite this article

Abstract

There are no guideline recommendations for the use of anticoagulant therapy in atrial fibrillation (AF) patients with cancer, which creates uncertainty about the optimal antithrombotic treatment in these patients. We conducted a network meta-analysis for the first time to assess the efficacy and safety of anticoagulant drugs in patients with AF and concurrent cancer. The PubMed, EMBASE, and Cochrane databases were searched up to March 2019. A search was made for the main anticoagulant drugs (warfarin, dabigatran, apixaban, rivaroxaban, and edoxaban). Outputs were presented as odds ratios (ORs), their corresponding 95% confidence intervals (CIs), and the surface under the cumulative ranking area (SUCRA) probabilities. We identified 414 relevant studies and included 5 trials involving 31,660 participants. In reducing the risk of stroke or systemic embolism, rivaroxaban and apixaban ranked the best and second best (SUCRA, 25.2% and 29.3%, respectively), followed by dabigatran, edoxaban, and warfarin. Apixaban and dabigatran were associated with lower probability of achieving at venous thromboembolism (VTE) (OR 0.12, 95% CI 0.05–0.52, SUCRA, 0.1%; and OR 0.24, 95% CI 0.07–1.00, SUCRA, 33.3%, respectively) than warfarin (SUCRA, 100.0%). For the prevention of all-cause death, apixaban was nonsignificantly less likely than warfarin. In addition, there were nonsignificant differences among all interventions in major bleeding, with the exception of apixaban vs. warfarin (OR 0.39, 95% CI 0.18–0.79; SUCRA 4.9%). In AF patients with cancer, nonvitamin K antagonist oral anticoagulants showed a lower incidence of stroke/systemic embolism, VTE, all-cause death, and major bleeding than warfarin, with apixaban being the best of those studied.

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Funding

This work was supported by the Provincial Plans - Social Development Areas - Major Projects of Jiangxi Province (No. 20161ACG70012), the Jiangxi Graduate Innovation Special Fund, and the State Scholarship Fund of the China Scholarship Council (CSC) under Grant No. 201906820003.

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Author notes

  1. Pingping Yang, Dan Zhu and Xiuxiu Xu contributed equally to this work.

Affiliations

  1. Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People’s Republic of China

    Pingping Yang, Dan Zhu, Xiuxiu Xu, Wen Shen, Chenxi Wang, Yu Jiang & Qinghua Wu

  2. Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

    Gaosi Xu

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  1. Pingping Yang
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Contributions

Y-PP, ZH-D, and X-XX performed the meta-analysis; S-W and W-CX were responsible for the statistical analysis; J-Y and X-GS provided editing assistance; and W-QH prepared the manuscript. All authors have reviewed and agreed to this information before submission.

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Correspondence to Qinghua Wu.

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Yang, P., Zhu, D., Xu, X. et al. Efficacy and safety of oral anticoagulants in atrial fibrillation patients with cancer—a network meta-analysis. Heart Fail Rev 25, 823–831 (2020). https://doi.org/10.1007/s10741-019-09844-8

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Keywords

  • Atrial fibrillation
  • Cancer
  • Oral anticoagulants
  • Meta-analysis