Abstract
BackgroundTo overcome the several drawbacks of warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were developed. Even though randomized controlled trials (RCTs) provided high-quality evidence, the real-world evidence is still needed. This systematic review and meta-analysis proposed to measure the safety and efficacy profile between warfarin and NOACs in non-valvular atrial fibrillation (NVAF) patients in preventing stroke.ResultsWe collected articles about the real-world studies comparing warfarin and NOACs for NVAF patients recorded in electronic scientific databases such as Embase, ProQuest, PubMed, and Cochrane. The pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the generic inverse variance method. A total of 34 real-world studies, including 2287288 NVAF patients, were involved in this study. NOACs effectively reduced the stroke risk than warfarin (HR 0.77; 95% CI 0.69 to 0.87; p < 0.01). Moreover, NOACs effectively lowered all-cause mortality risk (HR 0.71; 95% CI 0.63 to 0.81; p < 0.01). From the safety aspect, compared to warfarin, NOACs significantly reduced major bleeding risk (HR 0.68; 95% CI 0.54 to 0.86; p < 0.01) and intracranial bleeding risk (HR 0.54; 95% CI 0.42 to 0.70; p < 0.01). However, NOACs administration failed to decrease gastrointestinal bleeding risk (HR 0.78; 95% CI 0.58 to 1.06; p = 0.12).ConclusionsIn NVAF patients, NOACs were found to be more effective than warfarin at reducing stroke risk. NOACSs also lowered the risk of all-cause mortality, cerebral hemorrhage, and severe bleeding in NVAF patients compared to warfarin.
Highlights
To overcome the several drawbacks of warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were developed
Our result revealed that NOACs significantly reduced stroke risk in non-valvular atrial fibrillation (NVAF) patients (HR 0.77; 95% confidence interval (CI) 0.69 to 0.87; p < 0.01) compared to warfarin (Fig. 2)
In conclusion, our study demonstrated that NOACs had more efficacy than warfarin in preventing stroke in NVAF patients
Summary
To overcome the several drawbacks of warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were developed. A vitamin K antagonist (VKA), is an anticoagulant widely used worldwide It effectively reduces stroke risk and mortality in AF patients [7]. A prior study revealed that an INR value below 2.0 was related to the increased risk of stroke, while an INR value above 3.0 was related to the increased bleeding risk [9]. It can be a serious problem in patients with old age, noncompliance with medication, and various comorbidities
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