Non-vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation and Liver Disease: A M
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SYSTEMATIC REVIEW
Non‑vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation and Liver Disease: A Meta‑Analysis and Systematic Review Yonghui Fu1 · Wengen Zhu2 · Yue Zhou3 · He Chen4 · Lan Yan1 · Wenfeng He4
© Springer Nature Switzerland AG 2019
Abstract Background The effect of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) and liver disease remains largely unresolved. Therefore, we performed a meta-analysis to compare the efficacy and safety of NOACs with warfarin in this population. Methods We systematically searched the Cochrane Library, PubMed, and Embase databases for studies reporting the comparisons of NOACs with warfarin in patients with AF and liver disease. A random-effects model was selected to pool the risk ratios (RRs) and 95% confidence intervals (CIs). Results A total of six studies with 41,954 participants were included in this meta-analysis. In AF patients with liver disease, compared with warfarin use, the use of NOACs was associated with reduced risks of all-cause death (RR 0.78, 95% CI 0.66–0.93), major bleeding (RR 0.68, 95% CI 0.53–0.88), and intracranial hemorrhage (RR 0.49, 95% CI 0.41–0.59), but had comparable risks of stroke or system embolism (RR 0.80, 95% CI 0.57–1.12) and gastrointestinal bleeding (RR 0.90, 95% CI 0.61–1.34). In AF patients with cirrhosis, NOACs significantly reduced the risks of major bleeding (RR 0.53, 95% CI 0.37–0.76), gastrointestinal bleeding (RR 0.57, 95% CI 0.38–0.84), and intracranial hemorrhage (RR 0.55, 95% CI 0.31–0.97) compared with warfarin. Conclusions Based on current publications, the use of NOACs is at least non-inferior to warfarin in patients with AF and liver disease.
1 Introduction Atrial fibrillation (AF) is associated with increased risks of morbidity and mortality [1, 2], representing a major global Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40256-019-00369-x) contains supplementary material, which is available to authorized users. * Wenfeng He [email protected] 1
Department of Psychiatry, Jiangxi Mental Hospital, Nanchang 330029, Jiangxi, China
2
Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China
3
Department of Children’s Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
4
Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
health burden. Thromboembolic events are serious complications in AF patients. Current guidelines recommend oral anticoagulants for stroke prevention in patients with AF [3, 4]. Recently, non-vitamin K antagonist oral anticoagulants (NOACs) (one direct thrombin inhibitor, dabigatran, and three direct Xa inhibitors, rivaroxaban, apixaban, and edoxaban) have been increasingly used in clinical practice because of their better efficacy or safety profiles an
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