Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants) D-PO02 - Poster Session II (ID 47) Poster

D-PO02-223 - Use Of Direct Oral Anticoagulants In Patients With Cancer And Atrial Fibrillation: A Systematic Review And Meta-analysis (ID 263)

 B. Patel: Nothing relevant to disclose.


Background: Patients with cancer are at increased risk of systemic thromboembolism and bleeding events. In the absence of randomized trial data, little is known about the best antithrombotic strategy in patients with atrial fibrillation (AF) and cancer.
Objective: We performed a systematic literature review and meta-analysis of all published studies to assess efficacy and safety of direct oral anticoagulants (DOACs) versus warfarin in this patient population.
Methods: We searched PubMed, Medline, Embase, Ovid and Cochrane for studies reporting use of DOACs versus warfarin in patients with cancer and atrial fibrillation. Mantel-Haenszel risk ratio (RR) random effects model was used to summarize data between the two groups. Heterogeneity was assessed using I2 statistics.
Results: Seven studies (all retrospective) with a total of 35,502 patients (DOAC group = 13,780 and warfarin group = 21,722) met inclusion criteria. The majority of the patients were from two large databases (MarketScan and RELOAD). There was no difference in all-cause mortality between the two groups (RR 0.81; 95% CI 0.51-1.29, p = 0.38). There was significant heterogeneity between studies (I2 = 87%; p<0.0001). However, patients receiving DOAC had lower rates of systemic embolic events (RR 0.53; 95% CI 0.30-0.93, p = 0.03; I2 = 58%), lower major bleeding events (RR 0.58; 95% CI 0.38-0.88, p = 0.01; I2 = 81%) and trended towards lower ischemic stroke rates (RR 0.59; 95% CI 0.34-1.04, p = 0.07; I2 = 87%) compared to warfarin.
Conclusion: DOAC use was associated with lower systemic embolic and major bleeding events with no increased risk of all-cause mortality compared to warfarin in patients with cancer and AF.