Non-vitamin K antagonist oral anticoagulants in Asian patients with atrial fibrillation: evidences from the real-world d
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Non-vitamin K antagonist oral anticoagulants in Asian patients with atrial fibrillation: evidences from the real-world data Zhengbiao Xue 1 & Yue Zhou 2 & Chaoyu Wu 1 & Jie Lin 1 & Xin Liu 1 & Wengen Zhu 3
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract The role of non-vitamin K antagonist oral anticoagulants (NOACs) in stroke prevention remains unclear in Asian patients with atrial fibrillation (AF). Therefore, we performed a meta-analysis to compare the efficacy and safety outcomes of NOACs in Asian patients with AF from the real-world settings. The PubMed and Embase databases were systematically searched to identify eligible observational studies until June 2019. The odds ratios (OR) and 95% confidence intervals (CIs) were calculated and then pooled by a random-effects model. A total of 18 observational studies were included. Compared with warfarin, dabigatran (OR, 0.56, 95% CI 0.43–0.73), rivaroxaban (OR, 0.54, 95% CI 0.44–0.67), apixaban (OR, 0.41, 95% CI 0.35–0.48), and edoxaban (OR, 0.19, 95% CI 0.14– 0.25) reduced the risk of major bleeding, while dabigatran (OR, 0.78, 95% CI 0.71–0.85), rivaroxaban (OR, 0.74, 95% CI 0.68–0.82), and edoxaban (OR, 0.29, 95% CI 0.22–0.39) were associated with reduced risks of stroke or systemic embolism. In addition, dabigatran versus apixaban was associated with increased risks of ischemic stroke and gastrointestinal bleeding, while rivaroxaban versus apixaban was associated with elevated risks of stroke or systemic embolism, ischemic stroke, intracranial hemorrhage, and gastrointestinal bleeding. In Asian patients with AF, NOACs are non-inferior to warfarin for stroke prevention, and apixaban may be a better choice compared with dabigatran or rivaroxaban. Keywords Atrial fibrillation . Anticoagulants . Warfarin . Asian . Stroke prevention
Introduction Atrial fibrillation (AF) is the most common arrhythmias and increases the risk of thromboembolic events [1]. The use of oral anticoagulant therapy remains the mainstay to prevent the AFrelated stroke. The application of non-vitamin K antagonist oral anticoagulants (NOACs, including dabigatran, rivaroxaban, apixaban, and edoxaban) has generally increased due to their advantages over warfarin in terms of the reduced frequent Zhengbiao Xue and Yue Zhou are co-first authors Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10741-019-09878-y) contains supplementary material, which is available to authorized users. * Wengen Zhu [email protected] 1
Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
2
Department of Children’s Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
3
Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
monitoring of anticoagulant activity, and fewer drug-drug or drug-food interactions. Prior pivotal randomized clinical trials (RCTs)
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