Abstract Body (Do not enter title and authors here): Introduction: Anticoagulation therapy is crucial in enhancing perioperative outcomes, yet uncertainty persists regarding the optimal use of Direct Oral Anticoagulants (DOACs) and Vitamin K Antagonists (VKAs) in cardiovascular interventions. Key outcomes such as bleeding, thromboembolic events, and mortality are critical. Conducting a thorough review is essential to make well-informed decisions that improve patient quality of life and mitigate complications.
Hypothesis: This meta-analysis aimed to investigate whether Direct Oral Anticoagulants (DOACs) reduce perioperative complications such as bleeding, thromboembolic events, and mortality compared to Vitamin K Antagonists (VKAs) in patients undergoing cardiovascular procedures.
Methods: The present study was conducted in accordance with PRISMA guidelines. A systematic search was conducted in PubMed, MEDLINE, Scopus, Web of Science, Cochrane, and EMBASE databases on 05/14/2024. Data extraction was rigorously performed, and a random-effects model was used for data synthesis.
Results: The review included 25 studies involving a total of 25,754 patients. For bleeding risk, the meta-analysis showed that DOACs are associated with a lower risk compared to VKAs, with a relative risk (RR) of 0.69 (95% CI: 0.51 to 0.94, p = 0.0457, I² = 60%). Thromboembolic events showed no significant difference between DOACs and VKAs (RR: 1.13, 95% CI: 0.74 to 1.73, p = 0.5313, I² = 15%). Mortality outcomes also showed no significant difference (RR: 0.53, 95% CI: 0.20 to 1.43, p = 0.1622, I² = 68%).
Conclusion: The systematic review and meta-analysis demonstrate that DOACs are associated with a lower risk of bleeding compared to VKAs, with no significant difference in thromboembolic events and mortality. This evidence supports the substantial benefit of DOACs in cardiovascular interventions. Further research is needed to consolidate these findings and improve patient outcomes. PROSPERO registry— CRD42024547465