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Hypertrophic Cardiomyopathy and Atrial Fibrillation: A Systematic Review and Meta-analysis of Anticoagulation Strategy

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Abstract

Background

Atrial fibrillation (AF) frequently complicates hypertrophic cardiomyopathy (HCM), and anticoagulation significantly decreases the risk of stroke in this population. To date, no randomized controlled trials (RCTs) have compared direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). The present study aimed to systematically compare the two anticoagulation strategies in terms of effectiveness and safety.

Method

We performed a systematic literature search and meta-analysis in the PubMed, MEDLINE, and EMBASE databases for studies reporting all-cause mortality, major bleeding, or thromboembolic events (TEs). Since no RCTs were available, we included observational studies only. The overall hazard ratio (HR) and 95% confidence interval (CI) for each analyzed parameter were pooled using a random-effects model.

Results

Five observational studies including 6919 patients were eligible for inclusion. Compared with VKAs, DOACs were associated with statistically significant lower rates of all-cause mortality (HR 0.64, 95% CI 0.35–0.54; p < 0.00001), comparable major bleeding events (HR 0.64, 95% CI 0.40–1.03; p = 0.07), and TEs (HR 0.94, 95% CI 0.73–1.22; p = 0.65).

Conclusions

Compared with VKAs, a DOAC-based strategy might represent an effective and safe strategy regarding all-cause mortality, major/life-threatening bleeding complications, and TEs in HCM patients with concomitant AF. However, further prospective studies are necessary to reinforce a DOAC-based anticoagulation strategy in this population.

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Acknowledgements

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Authors and Affiliations

  1. Division of Cardiology, Department of Molecular Medicine, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy

    Federico Oliveri, Antonella Pepe, Andrea Bongiorno, Alessandro Fasolino, Francesca Romana Gentile, Davide Colombo, Federico Breviario, Mauro Acquaro & Lorenzo Tua

  2. Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Sandra Schirinzi, Alessandra Greco, Annalisa Turco, Laura Scelsi & Stefano Ghio

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  1. Federico Oliveri
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Correspondence to Federico Oliveri.

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Conflicts of interest

Federico Oliveri, Antonella Pepe, Andrea Bongiorno, Alessandro Fasolino, Francesca Romana Gentile, Sandra Schirinzi, Davide Colombo, Federico Breviario, Alessandra Greco, Annalisa Turco, Mauro Acquaro, Lorenzo Tua, Laura Scelsi, and Stefano Ghio declare they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Author contributions

All authors participated in the conceptualization, data curation, analysis, writing, reviewing and editing of this manuscript.

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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Oliveri, F., Pepe, A., Bongiorno, A. et al. Hypertrophic Cardiomyopathy and Atrial Fibrillation: A Systematic Review and Meta-analysis of Anticoagulation Strategy. Am J Cardiovasc Drugs 23, 269–276 (2023). https://doi.org/10.1007/s40256-023-00580-x

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