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Abstract：
BACKGROUND: The benefit-risk profile of direct oral anticoagulants (DOAC) therapy in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) has not been well established yet. This study aimed to evaluate the efficacy and safety of DOAC compared with vitamin K antagonists (VKA) in patients with HCM and AF.
METHODS: PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing DOAC with VKA in patients with HCM and AF. The primary endpoint was thromboembolic events. The relative risks and standard errors were pooled by random-effect models using the generic inverse variance method.
RESULTS: Seven observational studies involving 9395 patients were included in this meta-analysis. Compared to the VKA group, the DOAC group displayed a similar risk of thromboembolic events [RR (95%CI): 0.93 (0.73-1.20), p = 0.59] and ischemic stroke [RR (95%CI): 0.65 (0.33-1.28), p = 0.22]. The incidence of major bleeding was comparable between the two groups [RR (95%CI): 0.75 (0.49-1.15), p = 0.19]. Meanwhile, DOAC therapy was superior to VKA therapy in reducing the incidences of all-cause death [RR (95%CI): 0.44 (0.35-0.55), p < 0.001], cardiovascular death [RR (95%CI): 0.41 (0.22-0.75), p = 0.004], and intracranial hemorrhage [RR (95%CI): 0.42 (0.24-0.74), p = 0.003].
CONCLUSIONS: In patients with HCM and AF, DOAC therapy was similar to VKA therapy in reducing the risk of thromboembolic events, without increasing bleeding risk. In addition, the DOAC group displayed significant advantages in reducing mortality and intracranial hemorrhage compared with the VKA group. Further randomized controlled trials are needed to provide more evidence for DOAC therapy in this population.
METHODS: PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing DOAC with VKA in patients with HCM and AF. The primary endpoint was thromboembolic events. The relative risks and standard errors were pooled by random-effect models using the generic inverse variance method.
RESULTS: Seven observational studies involving 9395 patients were included in this meta-analysis. Compared to the VKA group, the DOAC group displayed a similar risk of thromboembolic events [RR (95%CI): 0.93 (0.73-1.20), p = 0.59] and ischemic stroke [RR (95%CI): 0.65 (0.33-1.28), p = 0.22]. The incidence of major bleeding was comparable between the two groups [RR (95%CI): 0.75 (0.49-1.15), p = 0.19]. Meanwhile, DOAC therapy was superior to VKA therapy in reducing the incidences of all-cause death [RR (95%CI): 0.44 (0.35-0.55), p < 0.001], cardiovascular death [RR (95%CI): 0.41 (0.22-0.75), p = 0.004], and intracranial hemorrhage [RR (95%CI): 0.42 (0.24-0.74), p = 0.003].
CONCLUSIONS: In patients with HCM and AF, DOAC therapy was similar to VKA therapy in reducing the risk of thromboembolic events, without increasing bleeding risk. In addition, the DOAC group displayed significant advantages in reducing mortality and intracranial hemorrhage compared with the VKA group. Further randomized controlled trials are needed to provide more evidence for DOAC therapy in this population.
摘要：
背景：在肥厚型心肌病（HCM）和心房颤动（AF）患者中，直接口服抗凝药（DOAC）治疗的获益-风险特征尚未完全确定。本研究旨在评估DOAC与维生素K拮抗剂（VKA）在HCM和AF患者中的疗效和安全性。
方法：PubMed，EMBASE,Cochrane图书馆,和clinicaltrials.gov进行搜索，以确定在HCM和AF患者中比较DOAC和VKA的研究。主要终点为血栓栓塞事件。使用通用逆方差方法通过随机效应模型汇集相对风险和标准误差。
结果：本荟萃分析包括7项观察性研究，涉及9395例患者。与VKA组相比,DOAC组显示出相似的血栓栓塞事件风险[RR(95CI):0.93(0.73-1.20),p=0.59]和缺血性卒中[RR（95CI）：0.65（0.33-1.28），p=0.22]。两组大出血的发生率相当[RR（95CI）：0.75（0.49-1.15），p=0.19]。同时,DOAC治疗在降低全因死亡发生率方面优于VKA治疗[RR(95CI):0.44(0.35-0.55),p<0.001],心血管死亡[RR（95CI）：0.41（0.22-0.75），p=0.004],和颅内出血[RR（95CI）：0.42（0.24-0.74），p=0.003]。
结论：在HCM和AF患者中，DOAC治疗与VKA治疗在降低血栓栓塞事件风险方面相似。不会增加出血风险。此外,与VKA组相比,DOAC组在降低死亡率和颅内出血方面显示出显著优势.需要进一步的随机对照试验为该人群的DOAC治疗提供更多证据。
方法：PubMed，EMBASE,Cochrane图书馆,和clinicaltrials.gov进行搜索，以确定在HCM和AF患者中比较DOAC和VKA的研究。主要终点为血栓栓塞事件。使用通用逆方差方法通过随机效应模型汇集相对风险和标准误差。
结果：本荟萃分析包括7项观察性研究，涉及9395例患者。与VKA组相比,DOAC组显示出相似的血栓栓塞事件风险[RR(95CI):0.93(0.73-1.20),p=0.59]和缺血性卒中[RR（95CI）：0.65（0.33-1.28），p=0.22]。两组大出血的发生率相当[RR（95CI）：0.75（0.49-1.15），p=0.19]。同时,DOAC治疗在降低全因死亡发生率方面优于VKA治疗[RR(95CI):0.44(0.35-0.55),p<0.001],心血管死亡[RR（95CI）：0.41（0.22-0.75），p=0.004],和颅内出血[RR（95CI）：0.42（0.24-0.74），p=0.003]。
结论：在HCM和AF患者中，DOAC治疗与VKA治疗在降低血栓栓塞事件风险方面相似。不会增加出血风险。此外,与VKA组相比,DOAC组在降低死亡率和颅内出血方面显示出显著优势.需要进一步的随机对照试验为该人群的DOAC治疗提供更多证据。
