Real-world comparisons of reduced-dose non-vitamin K antagonist oral anticoagulants versus warfarin in atrial fibrillati
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Real-world comparisons of reduced-dose non-vitamin K antagonist oral anticoagulants versus warfarin in atrial fibrillation: a systematic review and meta-analysis Xiaoping Wang 1 & Lili Fang 2 & Bin Liu 2 & Yongliang Zheng 2 & Junquan Zeng 3
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract We performed this meta-analysis to compare the efficacy and safety of reduced-dose non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients with atrial fibrillation (AF). The PubMed and Embase databases were systematically searched until July 2019 for eligible studies that comparing the effect between any reduced-dose NOAC and warfarin in patients with AF. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled by using a random-effects model. A total of 14 observational cohorts were included. Compared with warfarin use, the use of reduced-dose NOACs was associated with decreased risks of stroke or systemic embolism (RR, 0.83; 95% CI 0.74–0.93), ischemic stroke (RR, 0.87; 95% CI 0.77–0.98), major bleeding (RR, 0.71; 95% CI 0.60–0.84), intracranial hemorrhage (RR, 0.51; 95% CI 0.44–0.60), and gastrointestinal bleeding (RR, 0.72; 95% CI 0.54–0.94), but not all cause death (RR, 0.84; 95% CI 0.67–1.06). In the subgroup analyses, all NOAC users had lower or similar rates of thromboembolic and bleeding events; and the reductions in stroke or systemic embolism, all-cause death, major bleeding, and gastrointestinal bleeding were more prominent in Asians than non-Asians. In conclusion, current published data suggest that the use of reduced-dose NOACs is non-inferior to warfarin in patients with AF (in particular Asians). Keywords Atrial fibrillation . Anticoagulants . Outcomes . Stroke prevention
Introduction Appropriate thromboprophylaxis using anticoagulants is an urgent need among patients with atrial fibrillation (AF) [1, 2]. Previous phase III randomized clinical trials (RCTs) have indicated that non-vitamin K antagonist oral anticoagulants (NOACs, i.e., dabigatran, rivaroxaban, apixaban, and edoxaban) have improved benefit-harm profiles compared to warfarin in AF patients [3–6]. Based on the findings of pivotal trials, NOACs are considered to be the first-choice Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10741-019-09887-x) contains supplementary material, which is available to authorized users. * Junquan Zeng [email protected] 1
Comprehensive Teaching and Research Office, Ji’an College, Ji’an 34300, Jiangxi, China
2
Department of Hematology, The Affiliated Hospital of Jinggangshan University, Ji’an 343009, Jiangxi, China
3
Department of Internal Medicine, Jinggangshan University, Ji’an 34300, Jiangxi, China
medicine for stroke prevention in contemporary AF guidelines [1, 2]. A prior meta-analysis by including subgroup analyses from the NOAC trials [3–5] has proposed that reduced-dose NOACs prescribed according to drug indications pose favorable benefit-harm profiles compared with warfarin [7]. However, only nea
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