Table 2.
Efficacy and Safety of DOACs vs VKAs in patients with cancer and atrial fibrillation
| Outcome | Random-effects model | Fixed-effects model | Retrospective cohorts | Post-hoc analyses | Propensity-score matched cohorts | Active cancer cohorts | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RR and 95% CI | p-value | RR and 95% CI | p-value | RR and 95% CI | p-value | RR and 95% CI | p-value | RR and 95% CI | p-value | RR and 95% CI | p-value | |
| SSE | 0.65 (0.52–0.81) | 0.0001 | 0.68 (0.59–0.79) | < 0.00001 | 0.61 (0.49–0.80) | 0.0004 | 0.76 (0.54–1.07) | 0.11 | 0.53 (0.32–0.86) | 0.01 | 0.46 (0.27–0.78) | 0.004 |
| Ischemic Stroke | 0.84 (0.74–0.95) | 0.007 | 0.90 (0.88–0.93) | < 0.00001 | 0.85 (0.75–0.97) | 0.01 | 0.78 (0.38–1.58) | 0.49 | 0.65 (0.42–1.01) | 0.06 | 0.63 (0.40–0.99) | 0.05 |
| Hemorragic Stroke | 0.61 (0.52–0.71) | 0.00001 | 0.61 (0.54–0.69) | 0.00001 | 0.61 (0.51–0.73) | 0.00001 | 0.36 (0.04–3.24) | 0.36 | 0.36 (0.04–3.24) | 0.36 | N.A | N.A |
| MI | 0.71 (0.48–1.04) | 0.08 | 0.69 (0.49–0.96) | 0.03 | 0.81 (0.21–3.11) | 0.76 | 0.78 (0.51–1.19) | 0.25 | 0.84 (0.56–1.26) | 0.40 | 0.91 (0.34–2.43) | 0.85 |
| CV Death | 0.76 (0.53–1.09) | 0.14 | 0.76 (0.53–1.09) | 0.14 | N.A | N.A | 0.76 (0.53–1.09) | 0.14 | 0.76 (0.53–1.09) | 0.14 | 0.82 (0.53–1.27) | 0.37 |
| All-cause Death | 0.84 (0.59–1.20) | 0.34 | 0.92 (0.81–1.04) | 0.18 | 0.66 (0.30–1.43) | 0.29 | 1.01 (0.73–1.09) | 0.96 | 0.84 (0.59–1.20) | 0.34 | 0.74 (0.48–1.14) | 0.17 |
| MB | 0.68 (0.50–0.92) | 0.01 | 0.82 (0.71–0.96) | 0.01 | 0.53 (0.33–0.94) | 0.03 | 0.83 (0.65–1.06) | 0.13 | 0.67 (0.49–0.92) | 0.01 | 0.62 (0.42–0.90) | 0.01 |
| MB or CRNMB | 0.94 (0.78–1.13) | 0.50 | 0.94 (0.78–1.13) | 0.50 | N.A | N.A | 0.94 (0.78–1.13) | 0.50 | 0.94 (0.78–1.13) | 0.50 | 0.75 (0.52–1.07) | 0.11 |
| IC or GI Bleeding | 0.64 (0.47–0.88) | 0.006 | 0.83 (0.71–0.97) | 0.02 | 0.64 (0.44–0.92) | 0.02 | 0.30 (0.05–1.68) | 0.17 | 0.58 (0.39–0.87) | 0.008 | 0.65 (0.46–0.94) | 0.02 |
| Any Bleeding | 0.91 (0.78–1.06) | 0.24 | 0.92 (0.83–1.02) | 0.10 | 0.87 (0.64–1.18) | 0.37 | 0.93 (0.74–1.18) | 0.56 | 0.95 (0.81–1.12) | 0.55 | 0.95 (0.81–1.12) | 0.53 |
The RRs for each outcome obtained by pooling data using a random-effects model and different sensitivity analyses are shown
CI confidence interval, CV cardiovascular, IC intracranial, GI gastrointestinal, MI myocardial infarction, MB major bleeding, NMCRB non-major clinically relevant bleeding, RR relative risk, SSE stroke or systemic embolism