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NOACs superior to warfarin for atrial fibrillation

22 Aug 2018

In patients with atrial fibrillation (AF) naïve to oral anticoagulants (OACs), standard-dose nonvitamin K antagonist OACs (NOACs) provides better survival benefits than warfarin, a recent meta-analysis has shown.

Compared with warfarin, standard-dose NOACs yielded significantly lower rates of stroke or systemic thromboembolism (SSTE) in OAC-naïve patients (risk ratio [RR], 0.76; 95 percent CI, 0.67–0.87; p<0.001). The same was true with rates of major bleeding (RR, 0.84; 0.76–0.93; p<0.001), intracranial haemorrhage (RR, 0.56; 0.44–0.71) and all-cause mortality (RR, 0.90; 0.84–0.97; p=0.008).

In patients who had previously taken OACs, standard-dose NOACs resulted in a significantly lower all-cause mortality (RR, 0.92; 0.85–0.99; p=0.02). Rates of SSTE prevention and major bleeding were comparable between warfarin and standard-dose NOACs.

Notably, low-dose NOACs were likewise better than warfarin for secondary prevention of ischaemic stroke, leading to significantly reduced major bleeding (RR, 0.58; 0.48–0.70; p<0.001) and all-cause mortality (RR, 0.76; 0.66–0.88; p<0.001).

Moreover, among patients with primary prevention, standard-dose NOACs provided significantly better prevention of SSTEs than warfarin (RR, 0.78; 0.66–0.91; p=0.002) while low-dose NOACs did not. All-cause mortality remained lower with standard-dose NOACs vs warfarin in this subgroup (RR, 0.91; 0.85–0.97; p=0.004).

The databases of Medline, Embase, CENTRAL, Scopus and Web of Science were accessed for the present meta-analysis. A total of five phase-III randomized controlled trials were eligible for inclusion, from which the primary outcomes of bleeding and SSTE were analysed.

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