Aims 

Patients with cancer are at higher risk of atrial fibrillation, thromboembolic complications and bleeding events compared with the general population. The aim of the present meta-analysis was to compare the efficacy and safety of direct oral Xa inhibitor anticoagulants versus warfarin in patients with cancer and atrial fibrillation.

Methods 

We searched electronic databases for randomized controlled trials comparing direct oral Xa inhibitor anticoagulants and warfarin in cancer patients. The primary efficacy outcome was stroke or systemic embolism. The primary safety outcome was major bleeding. A subgroup analysis was performed to explore the outcome differences between patients with active cancer or history of cancer.

Results 

Three trials with a total of 3029 cancer patients were included in the analysis. There was no statistically significant difference in the risk of stroke or systemic embolism [risk ratio (RR) 0.76; 95% confidence interval (CI) 0.52–1.10] between the two therapeutic strategies. Direct oral Xa inhibitors significantly reduced the incidence of major bleeding compared with warfarin (RR 0.79; 95% CI 0.63–0.99; P = 0.04; number needed to treat = 113). These results were consistent both in patients with active cancer and in those with history of cancer.

Conclusion 

In patients with cancer and atrial fibrillation, direct oral Xa inhibitors have a similar efficacy and may be safer compared with warfarin. These results are consistent both in patients with active cancer and history of cancer.

中文翻译：

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癌症和房颤患者直接口服Xa抑制剂与华法林的比较：一项荟萃分析。

目的 

与普通人群相比，患有癌症的患者发生房颤，血栓栓塞并发症和出血事件的风险更高。本荟萃分析的目的是比较直接口服Xa抑制剂抗凝剂与华法林在癌症和房颤患者中的疗效和安全性。

方法 

我们在电子数据库中搜索了比较直接口服Xa抑制剂抗凝剂和华法林对癌症患者的随机对照试验。主要疗效结果为中风或全身性栓塞。主要安全结果是大出血。进行探索患者之间的差异的结果与积极的亚组分析癌症或病史癌症。

结果 

该分析包括对3029名癌症患者进行的三项试验。中风或全身性栓塞的风险没有统计学上的显着差异[风险比（RR）为0.76；两种治疗策略之间的95％置信区间（CI）0.52-1.10]。与华法林相比，直接口服Xa抑制剂可显着降低重大出血的发生率（RR 0.79； 95％CI 0.63-0.99；P = 0.04；需要治疗的数量= 113）。这些结果在活动性癌症患者和有癌症史的患者中都是一致的。

结论 

对于患有癌症和房颤的患者，直接口服Xa抑制剂的疗效相似，与华法林相比可能更安全。这些结果是患者积极一致的两种癌症和历史的癌症。