A systematic review and meta-analysis on the efficacy and safety of direct oral anticoagulants in patients with peripheral artery disease

• Verfasst von: Peppas, Spyros [VerfasserIn]
• Verfasst von: Sagris, Μarios [VerfasserIn]
• Verfasst von: Bikakis, Iosif [VerfasserIn]
• Verfasst von: Giannopoulos, Stefanos [VerfasserIn]
• Verfasst von: Tzoumas, Andreas [VerfasserIn]
• Verfasst von: Kokkinidis, Damianos G [VerfasserIn]
• Verfasst von: Ahmed, Zain [VerfasserIn]
• Verfasst von: Korosoglou, Grigorios [VerfasserIn]
• Verfasst von: Malgor, Emily A [VerfasserIn]
• Verfasst von: Malgor, Rafael D [VerfasserIn]
• Titel: A systematic review and meta-analysis on the efficacy and safety of direct oral anticoagulants in patients with peripheral artery disease
• Verf.angabe: Spyros Peppas, Μarios Sagris, Iosif Bikakis, Stefanos Giannopoulos, Andreas Tzoumas, Damianos G. Kokkinidis, Zain Ahmed, Grigorios Korosoglou, Emily A. Malgor, and Rafael D. Malgor
• E-Jahr: 2022
• Jahr: 28 February 2022
• Umfang: 11 S.
• Fussnoten: Available online 10 October 2021, version of record 28 February 2022 ; Gesehen am 02.08.2022
• Titel Quelle: Enthalten in: Annals of vascular surgery
• Ort Quelle: Orlando, Fla. : Elsevier, 1986
• Jahr Quelle: 2022
• Band/Heft Quelle: 80(2022), Seite 1-11
• ISSN Quelle: 1615-5947
• DOI: doi:10.1016/j.avsg.2021.07.028
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1812832567

Abstract

Background - PAD is a significant cause of morbidity and mortality affecting over 200 million people worldwide. Current guidelines recommend at least a single antiplatelet or anticoagulant agent in symptomatic PAD and lifelong antithrombotic treatment after a revascularization procedure. The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with peripheral artery disease (PAD). PAD is a significant cause of morbidity and mortality affecting over 200 million people worldwide. - Methods - The present systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Risk ratios (RR) were calculated using the random effects model. - Results - Overall, 10 studies were included in this systematic review and meta-analysis. In 4 studies, 14,257 patients with PAD were enrolled and they were assigned to receive either aspirin (ASA)+/- clopidogrel (N = 5,894) or DOAC+/- anti-platelet (e.g., ASA, clopidogrel) (n = 8,363). Non DOAC users were found to have higher reintervention rates (RR 1.12; 95% CI 1.01-1.24; P = 0.025) compared to DOAC users. No statistically significant difference was observed between the 2 groups, in terms of major bleeding (RR 0.78; 95% CI 0.50-1.23; P = 0.285), all-cause mortality (RR 0.98; 95% CI: 0.83-1.16; P = 0.818) and cardiovascular mortality (RR: 0.99; 95% CI: 0.73-1.333; P = 0.946) mortality. In addition, two real-world studies comparing DOAC with warfarin showed decreased rates of major cardiovascular events in the DOAC group. - Conclusion - DOAC use alone or combined with an anti-platelet agent could be associated with lower re-intervention rates, without increasing the risk for adverse bleeding events. However, this study failed to detect any difference in terms of all-cause mortality, MACEs and MALEs between DOAC users and DOAC naïve patients. Future studies are needed to better determine the efficacy and safety of DOACs in patients with PAD.