Thromboembolic Outcomes of Different Anticoagulation Strategies for Patients with Atrial Fibrillation in the Setting of Hypertrophic Cardiomyopathy: A Systematic Review

Matthew R Lozier; Alexandra M Sanchez; John J Lee; Elie M Donath; Vicente E Font; Esteban Escolar

doi:10.4022/jafib.2207

Thromboembolic Outcomes of Different Anticoagulation Strategies for Patients with Atrial Fibrillation in the Setting of Hypertrophic Cardiomyopathy: A Systematic Review

J Atr Fibrillation. 2019 Dec 31;12(4):2207. doi: 10.4022/jafib.2207. eCollection 2019 Dec.

Authors

Matthew R Lozier¹, Alexandra M Sanchez¹, John J Lee², Elie M Donath¹, Vicente E Font³, Esteban Escolar²

Affiliations

¹ University of Miami at Holy Cross Hospital, Division of Internal Medicine, Fort Lauderdale, FL, USA.
² Columbia University at Mount Sinai Medical Center, Division of Cardiology, Miami Beach, FL, USA.
³ Jim Moran Heart and Vascular Center at Holy Cross Hospital, Division of Cardiology, Fort Lauderdale, FL, USA.

Abstract

Objective: Limited data is available assessing the efficacy and safety of different anticoagulation (AC) strategies for prevention of thromboembolic events, major bleeding, and all-cause mortality in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). In this systematic review, we conducted a literature search to examine the possible association between different AC strategies and prevention of these adverse outcomes.

Methods: Scientific databases (PubMed, EMBASE, and Scopus) were searched using relevant medical subject headings and keywords to retrieve studies published through September of 2019. Studies assessing the outcomes of interest in patients with HCM and AF receiving AC, no AC as well as direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) were selected.

Results: This review identified 14 observational studies evaluating thromboembolic events by AC strategies in 8,479 participants with concomitant HCM and AF. The use of AC was associated with a lower pooled incidence rate of total thromboembolic events at 9.5% (112 events in 1,175 patients) compared to 22.1% with no AC (108 events in 489 patients). In addition, the use of DOACs was associated with a lower pooled incidence rate of thromboembolic events at 4.7% (169 events in 3,576 patients) compared to 8.7% with VKAs (281 events in 3,239 patients). Furthermore, the use of DOACs compared to VKAs was associated with a lower pooled incidence rate of major bleeding and all-cause mortality at 3.8% (136 events in 3,576 patients) versus 6.8% (220 events in 3,239 patients) and 4.1% (124 events in 3,008 patients) versus 16.1% (384 events in 2,380 patients), respectively.

Conclusions: AC of patients with concomitant HCM and AF was associated with a lower incidence of thromboembolic events when compared to antiplatelet therapy or no treatment. Treatment with DOACs was also associated with a lower incidence of thromboembolic events, major bleeding, and all-cause mortality when compared to VKAs.

Keywords: All-cause mortality; Anticoagulation; Atrial fibrillation; Direct oral anticoagulant; Hypertrophic cardiomyopathy; Major bleeding; Thromboembolism; Vitamin K antagonist.