SynthesisJournal of thrombosis and thrombolysis2021
Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta-analysis.
Synthesis in Journal of thrombosis and thrombolysis, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 4 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Anticoagulation approaches in hemodialysis: a systematic review of efficacy, safety, and literature gap.International urology and nephrology · 2026Pooled it
- Guideline
- 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2024Guideline
- Effectiveness and Safety of DOACs vs. VKAs in AF Patients With Cancer: Evidence From Randomized Clinical Trials and Observational Studies.Frontiers in cardiovascular medicine · 2021Pooled it
- Antithrombotic Therapy After PCI in High-Risk Cardiovascular Patients: Navigating Complexity Beyond Guidelines.Journal of clinical medicine · 2026Review
- Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulation in Atrial Fibrillation Patients at Very High Risk of Stroke: A Budget Impact Analysis in Italy.Journal of clinical medicine · 2026Article
- Atrial Fibrillation and Cancer: Pathophysiological Mechanism and Clinical Implications.Journal of clinical medicine · 2025Review
- Atrial Fibrillation in Patients with Breast Cancer: A Literature Review.Cardiology and therapy · 2025Review
- Multidisciplinary Approach in Atrial Fibrillation: As Good as Gold.Journal of clinical medicine · 2024Review
- Crosslink between atrial fibrillation and cancer: a therapeutic conundrum.Cardio-oncology (London, England) · 2024Review
- Direct Oral Anticoagulants in Special Patient Populations.Journal of clinical medicine · 2023Review
- Review
- Cardiac Arrhythmias in Oncological Patients-Epidemiology, Risk Factors, and Management within the Context of the New ESC 2022 Guidelines.Current oncology reports · 2023Review
- The Feasibility, Effectiveness and Acceptance of Virtual Visits as Compared to In-Person Visits among Clinical Electrophysiology Patients during the COVID-19 Pandemic.Journal of clinical medicine · 2023Article
- Direct Oral Anticoagulants for Stroke Prevention in Special Populations: Beyond the Clinical Trials.Biomedicines · 2023Review
- Incidence and Determinants of Spontaneous Cardioversion of Early Onset Symptomatic Atrial Fibrillation.Medicina (Kaunas, Lithuania) · 2022Review
- EHA Guidelines on Management of Antithrombotic Treatments in Thrombocytopenic Patients With Cancer.HemaSphere · 2022Article
- Five Years of Direct Oral Anticoagulants Use in Italy: Adverse Drug Reactions from the Italian National Pharmacovigilance Network.Journal of clinical medicine · 2022Article
- Anticoagulation and Stroke.Arquivos de neuro-psiquiatria · 2022Article
- Use of oral anticoagulants among individuals with cancer and atrial fibrillation in the United States, 2010-2016.Pharmacotherapy · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDirect oral anticoagulants (DOACs) are recommended as first-line anticoagulants in patients with atrial fibrillation (AF). However, in patients with cancer and AF the efficacy and safety of DOACs are not well established.
objectiveWe performed a meta-analysis comparing available data regarding the efficacy and safety of DOACs vs vitamin K antagonists (VKAs) in cancer patients with non-valvular AF.
methodsAn online search of Pubmed and EMBASE libraries (from inception to May, 1 2020) was performed, in addition to manual screening. Nine studies were considered eligible for the meta-analysis involving 46,424 DOACs users and 182,797 VKA users.
resultsThe use of DOACs was associated with reduced risks of systemic embolism or any stroke (RR 0.65; 95% CI 0.52-0.81; p 0.001), ischemic stroke (RR 0.84; 95% CI 0.74-0.95; p 0.007) and hemorrhagic stroke (RR 0.61; 95% CI 0.52-0.71; p 0.00001) as compared to VKA group. DOAC use was associated with significantly reduced risks of major bleeding (RR 0.68; 95% CI 0.50-0.92; p 0.01) and intracranial or gastrointestinal bleeding (RR 0.64; 95% CI 0.47-0.88; p 0.006). Compared to VKA, DOACs provided a non-statistically significant risk reduction of the outcomes major bleeding or non-major clinically relevant bleeding (RR 0.94; 95% CI 0.78-1.13; p 0.50) and any bleeding (RR 0.91; 95% CI 0.78-1.06; p 0.24).
conclusionsIn comparison to VKA, DOACs were associated with a significant reduction of the rates of thromboembolic events and major bleeding complications in patients with AF and cancer. Further studies are needed to confirm our results.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.