Safety and Efficacy of DOAC Versus VKA in Adult Congenital Heart Disease: A Systematic Review and Meta-Analysis
Rattachement africain : us, lb. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Patients with adult congenital heart disease (CHD) have various indications for anticoagulation (e.g., presence of Fontan circuit, atrial fibrillation due to surgical scar). Guidelines recommend vitamin K antagonists (VKA) for thromboprophylaxis in adult CHD, as trial data comparing safety/efficacy of direct oral anticoagulants (DOAC) to VKA are not available in this population. METHODS: PubMed/MEDLINE, Embase, Web of Science, and Google Scholar were searched for trials comparing DOAC with VKA in patients with ACHD. Outcomes of interest were efficacy endpoints (thromboembolic complications) and safety endpoints (bleeding complications). Results were meta-analyzed and sensitivity analyses were performed. RESULTS: A total of 4 retrospective studies comprising 6004 patients (2566 DOAC, 3438 VKA) were analyzed. Compared with VKA, DOAC did not cause a statistically significant difference in incidence of thromboembolism (risk ratio, RR, 0.76; 95% confidence intervals, CI, 0.28, 2.07); composite bleeding (RR 1.02, 95% CI 0.71, 1.47); major bleeding (RR 1.05, 95% CI 0.92, 1.21); minor bleeding (RR 1.12, 95% CI 0.51, 2.44); or intracranial bleeding (RR 0.86, 95% CI 0.50, 1.46). Numerically, the DOAC arm had fewer thromboembolisms/intracranial bleeds but more major/composite bleeds. However, upon removal of the largest study, the DOAC arm had fewer major/composite bleeds. CONCLUSIONS: DOAC did not confer a significant increase in either thromboembolic or bleeding risk as compared with VKA. Sensitivity analysis showed notable heterogeneity among studies. Large-scale trials comparing DOAC with VKA in patients with adult CHD are needed.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Safety and Efficacy of DOAC Versus VKA in Adult Congenital Heart Disease: A Systematic Review and Meta-Analysis
- Date Crossref
- 18/02/2025
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
-
Louisiana State University Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
-
Lebanese University pays non établi dans la noticeUniversité ou école supérieure
-
Louisiana State University Health Sciences Center Shreveport pays non établi dans la noticeÉtablissement de santé
-
Hartford Hospital Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
-
Louisiana State University in Shreveport pays non établi dans la noticeUniversité ou école supérieure
-
Faculty of Medical Sciences pays non établi dans la noticeUniversité ou école supérieure
-
McGovern School of Medicine Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
-
Lousiana State University Health Shreveport Health Sciences Library pays non établi dans la noticeUniversité ou école supérieure
Department of Internal Medicine — Louisiana State University, Lebanese University et Louisiana State University Health Sciences Center Shreveport, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.