Efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients(≥80 Years of Age) with atrial fibrillation: systematic review and meta-analysis.

Abstract

Findings of prior studies about the efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients(≥80 Years of Age) with atrial fibrillation are controversial. So we perform the meta-analysis to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants versus vitamin-K antagonists (VKAs) in patients(≥80 Years of Age) with atrial fibrillation. A systematic review of PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical databases was conducted up to October 1st 2022. Studies reporting the effects and safety of NOACs versus warfarin in patients(≥80 years of age) with atrial fibrillation were included. Two authors independently performed study selection and data extraction. Discrepancies were resolved by consensus or through an independent third reviewer. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews guidelines. We identified 15 studies providing data of 70446 participants(≥80 Years of Age) suffered from atrial fibrillation. On meta-analysis (odds ratio[OR] [95% confidence interval{CI}]), NOACs conferred better efficacy profile than VKAs in stroke and systemic embolism (0.8 [0.73-0.88]) and all-cause mortality(0.61 [0.57-0.65]). Otherwise, NOACs conferred better safety profile than VKAs in major bleeding(0.76 [0.70-0.83]) and intracranial hemorrhage(0.57 [0.47-0.68]). In conclusion, for patients(≥80 Years of Age) with atrial fibrillation, the risks of stroke and systemic embolism, all-cause mortality were lower in NOACs compared to warfarin. While the risks of major bleeding, intracranial hemorrhage were also lower in NOACs compared to warfarin too. NOACs showed better efficacy and safety compared to warfarin. This article is protected by copyright. All rights reserved.