The Risk of Gastrointestinal Bleeding between Non-Vitamin K Antagonist Oral Anticoagulants and Vitamin K Antagonists in the Asian Atrial Fibrillation Patients: A Meta-Analysis

Kuang-Tsu Yang,Feng-Woei Tsay,Jin-Shiung Cheng,Tzung-Jiun Tsai,Wen-Chi Chen,Wei-Chih Sun

doi:10.3390/ijerph18010137

Abstract

Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are more commonly used to prevent atrial fibrillation (AF) patients from thromboembolic events than vitamin K antagonists (VKAs). However, the gastrointestinal bleeding (GIB) risk in the Asian AF patients associated with NOACs in comparison with VKAs remained unaddressed. Materials and Methods: A systematic search of studies on NOACs and VKAs in the Asian AF patients was conducted in PubMed, Cochrane Library, and ClinicalTrials.gov. The primary outcome was the hazard ratio (HR) of any GIB associated with NOACs versus VKAs. The secondary outcome was the GIB risks in different kinds of NOACs compared with VKAs. Results: This meta-analysis included two randomized controlled trials (RCTs) and four retrospective studies, comprising at least 200,000 patients in total. A significantly lower HR of GIB risks was found in all kinds of NOACs than VKAs in the Asian AF patients (HR: 0.633; 95% confidence interval: 0.535–0.748; p < 0.001). Additionally, the GIB risks of different NOACs were apixaban (HR: 0.392), edoxaban (HR: 0.603), dabigatran (HR: 0.685), and rivaroxaban (HR: 0.794), respectively. Conclusions: NOACs significantly reduced the risk of GIB in the Asian AF patients compared with VKAs. In the four NOACs compared with VKAs, apixaban probably had a trend of the least GIB risk. We need further head-to-head studies of different NOACs to confirm which NOAC is the most suitable for Asian AF patients and to know the optimal dosage regimen of different NOACs.

Highlights

The overall atrial fibrillation (AF) prevalence is about 1% worldwide, and nearly 10%in populations older than 80 years old [1]
We investigated studies with a gastrointestinal bleeding (GIB) risk evaluation and employing the Asian AF patients receiving different kinds of Non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs)
The search strategy (File S2) comprised the following keywords variably combined with rivaroxaban, Xarelto, dabigatran, Pradaxa, apixaban, Eliquis, edoxaban, Lixiana, novel oral anticoagulant, new oral anticoagulant, direct oral anticoagulant, NOAC, DOAC, novel, new, oral, anticoagulant, coagulant, oral anticoagulant, OAC, antithrombin, thrombin, factor Xa inhibitor, Xa inhibitor, factor IIa inhibitor, IIa inhibitor, Non-vitamin K antagonist, gastrointestinal bleeding, GIB, GI bleeding, gastrointestinal, bleeding, gastrointestinal hemorrhage, GI hemorrhage, hemorrhage, warfarin, vitamin K antagonist, VKA, atrial fibrillation, AF, Afib, Asia, Asian, Taiwan, Taiwanese, China, Chinese, Abkhazian, Iran, Palestine, Afghanistan, Iraq, Akrotiri, Dhekelia, Israel, Philippines, Japan, Japanese, Qatar, Armenia, Jordan, Azerbaijan, Kazakh, Bahrain, North

Summary

Introduction

The overall atrial fibrillation (AF) prevalence is about 1% worldwide, and nearly 10%in populations older than 80 years old [1]. Asian AF patients under vitamin K antagonists (VKAs, warfarin) use encountered bleeding events and would seldom reach an optimal international normalized ratio control when taking VKAs

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