EFFICACY AND SAFETY OF ANTICOAGULATION IN PATIENTS WITH SEPSIS AND ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 29,485 PATIENTS
Topic: Acute conditions in cardiology | |
| Type: Presentation - doctors , Number in the programme: 496 | |
| Faizollah Zadeh Ardebili S. 1, Galvao da Silva De Paula L. 2, Angel Samaniego Laguna M. 3, Shah T. 4, Melfior L. 5, De Paula Portilho N. 6 1 Department of Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, 2 Department of Medicine, Faculdade de Medicina Souza Marques, Rio de Janeiro, Brazil, 3 Department of Medicine, Metropolitan Autonomous University, Mexico City, Mexico, 4 Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, 5 Department of Medicine, University of Santa Catarina, Florianópolis, Brazil, 6 Department of Cardiology, Federal District Military Firefighter Brigade, Brasília, Brazil | |
Background: Atrial fibrillation (AF) in the setting of sepsis is associated with an increased risk of ischemic stroke during hospitalization. Whether the use of anticoagulation (AC) in this population can improve outcomes remains uncertain. Methods: To address this gap, we systematically searched PubMed, Embase, and Cochrane databases for studies that evaluated the efficacy and safety of AC compared to control in patients with AF and sepsis. Risk ratios (RR) and mean differences (MD) with their corresponding 95% confidence intervals (CI) were pooled with a random effects model. When available, data from propensity score-matched (PSM) studies were prioritized to minimize confounding. Results: This meta-analysis included 29,485 patients (49.9% receiving AC) across 6 retrospective studies (3 PSM). Compared to control, in-hospital AC was associated with a significant reduction in mortality (RR 0.62; 95% CI 0.40-0.94; p = 0.026; Figure 1), while increasing the risk of bleeding (RR 1.19; 95% CI 1.10-1.29; p < 0.001; Figure 2A) and non-significantly increasing the risk of major bleeding (RR 1.49; 95% CI 0.99-2.26; p = 0.058; Figure 2B). No differences were observed between groups for in-hospital ischemic stroke (RR 0.94; 95% CI 0.77-1.15; p = 0.561; Figure 3), or ICU and hospital lengths of stay. In unadjusted analyses of 2 studies, out-patient AC was associated with a significant increase in ischemic stroke risk (RR 1.58; 95% CI 1.02-2.44; p = 0.039) with similar bleeding events to control (RR 1.17; 95% CI 0.88-1.55; p = 0.286). Conclusion: Our findings suggest that in-hospital use of AC in patients with sepsis and AF may significantly reduce mortality, but at the cost of increased bleeding. Future studies should aim to identify subgroups with the most net benefit. Prospective randomized trials are warranted before routine recommendations can be made. | |
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