Factor Xa inhibitors vs. warfarin in patients with Hughes syndrome: a systematic review and meta-analysis of randomized controlled trials

The optimal treatment regimen for patients with Hughes syndrome remains unclear. Therefore, the authors sought to compare the outcomes of warfarin vs. factor Xa inhibitors in patients with Hughes syndrome. MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials...

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Veröffentlicht in:Annals of medicine and surgery 2024-05, Vol.86 (5), p.2992-3000
Hauptverfasser: Mohtashim, Ali, Azhar, Aima, Mazhar, Saad, Devi, Deepa, Danial, Muhammad, Patel, Dhruvilkumar, Khan, Owais, Andani, Anushka, Khan, Muhammad Mohib, Samad, Shahzaib, Qureshi, Aena, Ali, Hafsa, Ejaz, Umer, Jawad, Sayed
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container_issue 5
container_start_page 2992
container_title Annals of medicine and surgery
container_volume 86
creator Mohtashim, Ali
Azhar, Aima
Mazhar, Saad
Devi, Deepa
Danial, Muhammad
Patel, Dhruvilkumar
Khan, Owais
Andani, Anushka
Khan, Muhammad Mohib
Samad, Shahzaib
Qureshi, Aena
Ali, Hafsa
Ejaz, Umer
Jawad, Sayed
description The optimal treatment regimen for patients with Hughes syndrome remains unclear. Therefore, the authors sought to compare the outcomes of warfarin vs. factor Xa inhibitors in patients with Hughes syndrome. MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) comparing 8 efficacy and safety of warfarin and factor Xa inhibitors in patients with Hughes syndrome. Recurrent thrombosis, all-cause mortality, stroke, adverse reactions, and bleeding were among 10 outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate 11 relative risks (RRs) with 95% CIs. The analysis included 625 patients from four RCTs and one post-hoc analysis. Meta-analysis showed a statistically non-significant difference between factor Xa inhibitors and warfarin in the recurrent thrombosis risk (arterial or venous) [RR 2.77 (95%, CI 0.79, 9.65); =0.11, I =50%]. Consistent results were revealed among patients with a previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); =0.75, I =0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); =0.31, I =15%] and patients who were triple antiphospholipid antibodies (aPL) positive [RR 4.12 (95% CI 0.46, 37.10); 21 =0.21, I =58%]. Factor Xa inhibitors were significantly associated with an increased risk of stroke [RR 8.51 (95% CI 2.35, 13.82); =0.47, I =0%]. Factor Xa inhibitors exhibited an increased risk of stroke among patients with Hughes syndrome. In addition, although not significant, the higher RRs among patients on factor Xa inhibitors may indicate a higher risk of thrombotic events associated with factor Xa inhibitors.
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Therefore, the authors sought to compare the outcomes of warfarin vs. factor Xa inhibitors in patients with Hughes syndrome. MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) comparing 8 efficacy and safety of warfarin and factor Xa inhibitors in patients with Hughes syndrome. Recurrent thrombosis, all-cause mortality, stroke, adverse reactions, and bleeding were among 10 outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate 11 relative risks (RRs) with 95% CIs. The analysis included 625 patients from four RCTs and one post-hoc analysis. Meta-analysis showed a statistically non-significant difference between factor Xa inhibitors and warfarin in the recurrent thrombosis risk (arterial or venous) [RR 2.77 (95%, CI 0.79, 9.65); =0.11, I =50%]. Consistent results were revealed among patients with a previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); =0.75, I =0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); =0.31, I =15%] and patients who were triple antiphospholipid antibodies (aPL) positive [RR 4.12 (95% CI 0.46, 37.10); 21 =0.21, I =58%]. Factor Xa inhibitors were significantly associated with an increased risk of stroke [RR 8.51 (95% CI 2.35, 13.82); =0.47, I =0%]. Factor Xa inhibitors exhibited an increased risk of stroke among patients with Hughes syndrome. 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Consistent results were revealed among patients with a previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); =0.75, I =0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); =0.31, I =15%] and patients who were triple antiphospholipid antibodies (aPL) positive [RR 4.12 (95% CI 0.46, 37.10); 21 =0.21, I =58%]. Factor Xa inhibitors were significantly associated with an increased risk of stroke [RR 8.51 (95% CI 2.35, 13.82); =0.47, I =0%]. Factor Xa inhibitors exhibited an increased risk of stroke among patients with Hughes syndrome. 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title Factor Xa inhibitors vs. warfarin in patients with Hughes syndrome: a systematic review and meta-analysis of randomized controlled trials
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