The benefit-risk profile of direct oral anticoagulants (DOAC) therapy in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) has not been well established yet. This study aimed to evaluate the efficacy and safety of DOAC compared with vitamin K antagonists (VKA) in patients with HCM and AF. PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing DOAC with VKA in patients with HCM and AF. The primary endpoint was thromboembolic events. The relative risks and standard errors were pooled by random-effect models using the generic inverse variance method. Seven observational studies involving 9395 patients were included in this meta-analysis. Compared to the VKA group, the DOAC group displayed a similar risk of thromboembolic events [RR (95%CI): 0.93 (0.73–1.20), p = 0.59] and ischemic stroke [RR (95%CI): 0.65 (0.33–1.28), p = 0.22]. The incidence of major bleeding was comparable between the two groups [RR (95%CI): 0.75 (0.49–1.15), p = 0.19]. Meanwhile, DOAC therapy was superior to VKA therapy in reducing the incidences of all-cause death [RR (95%CI): 0.44 (0.35–0.55), p < 0.001], cardiovascular death [RR (95%CI): 0.41 (0.22–0.75), p = 0.004], and intracranial hemorrhage [RR (95%CI): 0.42 (0.24–0.74), p = 0.003]. In patients with HCM and AF, DOAC therapy was similar to VKA therapy in reducing the risk of thromboembolic events, without increasing bleeding risk. In addition, the DOAC group displayed significant advantages in reducing mortality and intracranial hemorrhage compared with the VKA group. Further randomized controlled trials are needed to provide more evidence for DOAC therapy in this population.

中文翻译：

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直接口服抗凝药与维生素K拮抗剂相比对肥厚型心肌病合并房颤患者的疗效和安全性

直接口服抗凝剂（DOAC）治疗肥厚型心肌病（HCM）和心房颤动（AF）患者的获益-风险特征尚未明确。本研究旨在评估 DOAC 与维生素 K 拮抗剂 (VKA) 相比对 HCM 和 AF 患者的疗效和安全性。检索了 PubMed、EMBASE、Cochrane 图书馆和 ClinicalTrials.gov，以找出比较 DOAC 与 VKA 在 HCM 和 AF 患者中的研究。主要终点是血栓栓塞事件。使用通用逆方差方法通过随机效应模型汇总相对风险和标准误差。这项荟萃分析纳入了七项观察性研究，涉及 9395 名患者。与 VKA 组相比，DOAC 组的血栓栓塞事件风险相似 [RR (95% CI)：0.93 (0.73–1.20)，p = 0.59] 和缺血性卒中 [RR (95% CI)：0.65 (0.33– 1.28），p = 0.22]。两组之间大出血的发生率相当[RR (95%CI): 0.75 (0.49–1.15), p = 0.19]。同时，DOAC 治疗在降低全因死亡发生率方面优于 VKA 治疗 [RR (95% CI)：0.44 (0.35–0.55)，p < 0.001]、心血管死亡 [RR (95% CI)：0.41 ( 0.22–0.75), p = 0.004] 和颅内出血 [RR (95%CI): 0.42 (0.24–0.74), p = 0.003]。在 HCM 和 AF 患者中，DOAC 治疗在降低血栓栓塞事件风险方面与 VKA 治疗相似，且不会增加出血风险。此外，与VKA组相比，DOAC组在降低死亡率和颅内出血方面表现出显着优势。需要进一步的随机对照试验来为该人群中 DOAC 治疗提供更多证据。