Direct oral anticoagulants vs. vitamin K antagonists in patients with antiphospholipid syndrome: a systematic review and meta-analysis.

Autor:	Shah BB; Department of Medicine, Kathmandu Medical College, Kathmandu., Shankar A; Department of Internal Medicine, West Anaheim Medical Centre, Anaheim, CA., Kumar V; Department of Medicine, Chandka Medical College, Larkana., Kumar S; Department of Internal Medicine, Dow University of Health Sciences., Malik UA; Department of Medicine, Aga Khan Medical University., Majeed A; Department of Medicine, Liaquat College of Medicine and Dentistry., Kumar V; Departments of Internal Medicine., Berkha; Department of Medicine, Peoples Medical College, Nawabshah, Pakistan., Suman; Department of Medicine, Chandka Medical College, Larkana., Kumar S; Medicine, Liaquat University of Medical & Health Sciences, Karachi., Netha A; Department of Medicine, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu, India., Subedi S; Department of Medicine, Chitwan Medical College, Bharatpur, Nepal., Ahmed S; Department of Medicine, Kabul Medical University, Kabul, Afghanistan.
Jazyk:	angličtina
Zdroj:	Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2023 May 25; Vol. 85 (7), pp. 3574-3582. Date of Electronic Publication: 2023 May 25 (Print Publication: 2023).
DOI:	10.1097/MS9.0000000000000903
Abstrakt:	Optimal treatment regimen for patients with antiphospholipid syndrome (APS) remain unclear. Therefore, the authors sought to compare the outcomes of vitamin K antagonists (VKAs) vs. direct oral anticoagulants (DOACs) in patients with APS. Methods: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials comparing efficacy and safety of VKAs and DOACs inhibitors in patients with APS. Recurrent thrombosis, all-cause mortality, stroke, adverse reactions, and bleeding were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs. Results: The analysis included 625 patients from four randomized controlled trials and one post hoc analysis. Meta-analysis showed statistically non-significant difference between DOACs inhibitors and VKAs in the recurrent thrombosis risk (arterial or venous) [RR 2.77 (95%, CI 0.79, 9.65); P =0.11, I 2 =50%]. Consistent results were revealed among patients with the previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); P =0.75, I 2 =0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); P =0.31, I 2 =15%] and patients who were triple antiphospholipid positive [RR 4.12 (95% CI 0.46, 37.10); P =0.21, I 2 =58%]. DOACs inhibitors were significantly associated with increased risk of stroke [RR 8.51 (95% CI 2.35, 3.82); P =0.47, I 2 =0%]. Conclusion: DOACs exhibited increased risk of stroke among patients with APS. In addition, although not significant, the higher RRs among patients on DOACs may indicate higher risk of thrombotic events associated with DOACs. Competing Interests: None to declare. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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