Safety and Efficacy of Direct Oral Anticoagulants vs Warfarin for Atrial
Fibrillation in Cancer Patients: A Systematic Review and Meta-analysis
Abstract
Background Patients with cancer are at increased risk of atrial
fibrillation (AF) while cancer is also associated with increased risk of
thromboembolism as well as bleeding. Direct oral anticoagulants (DOACs)
have emerged as an alternative to warfarin for AF to reduce
thromboembolic events, however, the studies on these anticoagulation
strategies in cancer patients are limited. Objective We aimed
to conduct a systematic review and meta-analysis to compare the efficacy
and safety of DOACs vs warfarin in cancer patients. Methods 13
studies were included in the meta-analysis comparing DOAC treatment to
warfarin for AF in cancer patients. Outcomes studied were all-cause
mortality, cardiovascular death, acute myocardial infarction (AMI),
bleeding and thromboembolic events. Mantel-Haenszel method was used to
calculate pooled log odds-ratio (OR) for binary outcomes and Hedges’ g
using inverse-variance method for continuous outcomes. We used random
effects model with 95% confidence interval (CI) for statistical
significance. Results DOACs as compared to warfarin in cancer
patients with AF were associated with decreased odds of all-cause
mortality (OR 0.67, 95% CI 0.48-0.94, I 2=96%,
p=0.019), cardiovascular deaths (OR 0.62, 95% CI 0.49-0.79, I
2= 0%, p<0.001), AMI (OR 0.66, 95% CI
0.49-0.89, I 2= 0%, p<0.01), combined
ischemic stroke and systemic embolic events.