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
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 periphe...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/2/65 |
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| author | Enikő Pomozi Rita Nagy Péter Fehérvári Péter Hegyi Boldizsár Kiss Fanni Dembrovszky Annamária Kosztin Sándor Nardai Endre Zima Zoltán Szeberin |
| author_facet | Enikő Pomozi Rita Nagy Péter Fehérvári Péter Hegyi Boldizsár Kiss Fanni Dembrovszky Annamária Kosztin Sándor Nardai Endre Zima Zoltán Szeberin |
| author_sort | Enikő Pomozi |
| collection | DOAJ |
| description | 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, <i>p</i> < 0.01), stroke/systemic embolism (HR 0.76; 95% CI 0.61–0.95; <i>p</i> < 0.01), and all-cause mortality (HR 0.78; 95% CI 0.66–0.92; <i>p</i> < 0.01) compared with warfarin, but showed similar risks of MI (HR = 0.81, 95% CI, 0.59–1.11, <i>p</i> = 0.2) and cardiovascular mortality (HR = 0.77, 95% CI, 0.58–1.02, <i>p</i> = 0.07). Rivaroxaban at higher doses significantly increased the risk of major bleeding (HR = 1.16, 95% CI, 1.07–1.25, <i>p</i> < 0.01). We found no significant difference in terms of revascularization (OR = 1.49, 95% CI, 0.79–2.79, <i>p</i> = 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. |
| first_indexed | 2024-03-11T08:39:01Z |
| format | Article |
| id | doaj.art-c4f7f7f97afe4f48912ba13c3be090c1 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-11T08:39:01Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-c4f7f7f97afe4f48912ba13c3be090c12023-11-16T21:16:32ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-02-011026510.3390/jcdd10020065Direct Oral Anticoagulants as the First Choice of Anticoagulation for Patients with Peripheral Artery Disease to Prevent Adverse Vascular Events: A Systematic Review and Meta-AnalysisEnikő Pomozi0Rita Nagy1Péter Fehérvári2Péter Hegyi3Boldizsár Kiss4Fanni Dembrovszky5Annamária Kosztin6Sándor Nardai7Endre Zima8Zoltán Szeberin9Department of Vascular and Endovascular Surgery, Semmelweis University, 1122 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, 1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, 1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, 1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, 1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, 1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, 1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, 1085 Budapest, HungaryCentre for Translational Medicine, Semmelweis University, 1085 Budapest, HungaryDepartment of Vascular and Endovascular Surgery, Semmelweis University, 1122 Budapest, HungaryThe 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, <i>p</i> < 0.01), stroke/systemic embolism (HR 0.76; 95% CI 0.61–0.95; <i>p</i> < 0.01), and all-cause mortality (HR 0.78; 95% CI 0.66–0.92; <i>p</i> < 0.01) compared with warfarin, but showed similar risks of MI (HR = 0.81, 95% CI, 0.59–1.11, <i>p</i> = 0.2) and cardiovascular mortality (HR = 0.77, 95% CI, 0.58–1.02, <i>p</i> = 0.07). Rivaroxaban at higher doses significantly increased the risk of major bleeding (HR = 1.16, 95% CI, 1.07–1.25, <i>p</i> < 0.01). We found no significant difference in terms of revascularization (OR = 1.49, 95% CI, 0.79–2.79, <i>p</i> = 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.https://www.mdpi.com/2308-3425/10/2/65peripheral artery diseaseatrial fibrillationoral anticoagulantsbleedingcardiovascular outcomeslower-limb complications |
| spellingShingle | Enikő Pomozi Rita Nagy Péter Fehérvári Péter Hegyi Boldizsár Kiss Fanni Dembrovszky Annamária Kosztin Sándor Nardai Endre Zima Zoltán Szeberin 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 Journal of Cardiovascular Development and Disease peripheral artery disease atrial fibrillation oral anticoagulants bleeding cardiovascular outcomes lower-limb complications |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | peripheral artery disease atrial fibrillation oral anticoagulants bleeding cardiovascular outcomes lower-limb complications |
| url | https://www.mdpi.com/2308-3425/10/2/65 |
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