Direct Oral Anticoagulants as the First Choice of Anticoagulation for Patients with Peripheral Artery Disease to Prevent Adverse Vascular Events: A Systematic Review and Meta-Analysis.
Enikő PomoziRita NagyPéter FehérváriPéter HegyiBoldizsár KissFanni DembrovszkyAnnamária KosztinSándor NardaiEndre ZimaZoltán SzeberinPublished in: Journal of cardiovascular development and disease (2023)
The best method of anticoagulation for patients with peripheral artery disease (PAD) is still a topic of interest for physicians. We conducted a meta-analysis to compare the effects of direct oral anticoagulants (DOACs) with those of vitamin-K-antagonist (VKA) anticoagulants in patients with peripheral artery disease. Five databases (Medline (via PubMed), EMBASE, Scopus, Web of Science, and CENTRAL) were searched systematically for studies comparing the effects of the two types of anticoagulants in patients with PAD, with an emphasis on lower-limb outcomes, cardiovascular events, and mortality. In PAD patients with concomitant non-valvular atrial fibrillation (NVAF), the use of DOACs significantly reduced the risk of major adverse limb events (HR = 0.58, 95% CI, 0.39-0.86, p < 0.01), stroke/systemic embolism (HR 0.76; 95% CI 0.61-0.95; p < 0.01), and all-cause mortality (HR 0.78; 95% CI 0.66-0.92; p < 0.01) compared with warfarin, but showed similar risks of MI (HR = 0.81, 95% CI, 0.59-1.11, p = 0.2) and cardiovascular mortality (HR = 0.77, 95% CI, 0.58-1.02, p = 0.07). Rivaroxaban at higher doses significantly increased the risk of major bleeding (HR = 1.16, 95% CI, 1.07-1.25, p < 0.01). We found no significant difference in terms of revascularization (OR = 1.49, 95% CI, 0.79-2.79, p = 0.14) in PAD patients in whom a poor distal runoff was the reason for the anticoagulation. DOACs have lower rates of major limb events, stroke, and mortality than VKAs in PAD patients with atrial fibrillation. Rivaroxaban at higher doses increased the risk of major bleeding compared with other DOAC drugs. More high-quality studies are needed to determine the most appropriate anticoagulation regimen for patients with lower-limb atherosclerosis.
Keyphrases
- atrial fibrillation
- direct oral anticoagulants
- peripheral artery disease
- cardiovascular events
- lower limb
- oral anticoagulants
- left atrial
- catheter ablation
- left atrial appendage
- cardiovascular disease
- venous thromboembolism
- percutaneous coronary intervention
- coronary artery disease
- heart failure
- end stage renal disease
- risk factors
- primary care
- peritoneal dialysis
- emergency department
- newly diagnosed
- minimally invasive
- chronic kidney disease
- artificial intelligence
- risk assessment
- human health
- skeletal muscle
- left ventricular
- patient reported outcomes
- big data