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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
  • Lili Fang
  • Bin Liu
  • Yongliang Zheng
  • Junquan ZengEmail author
Article
  • 131 Downloads

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 

Notes

Author contributions

Xiaoping Wang, and Junquan Zeng contributed to the whole process of this meta-analysis including study design, literature search, data curation, methodology, data analysis, and data interpretation and drafted the manuscript. Lili Fang, Bin Liu, and Yongliang Zheng help revised the original draft.

Funding information

This study was supported by Jiangxi Educational Department Foundation of China(NO.GJJ170628, 170656, 160761, GL1569).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not required.

Supplementary material

10741_2019_9887_MOESM1_ESM.pdf (1.1 mb)
ESM 1 (PDF 1150 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Xiaoping Wang
    • 1
  • Lili Fang
    • 2
  • Bin Liu
    • 2
  • Yongliang Zheng
    • 2
  • Junquan Zeng
    • 3
    Email author
  1. 1.Comprehensive Teaching and Research OfficeJi’an CollegeJi’anChina
  2. 2.Department of HematologyThe Affiliated Hospital of Jinggangshan UniversityJi’anChina
  3. 3.Department of Internal MedicineJinggangshan UniversityJi’anChina

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