Warfarin with TCM yields less thromboembolic events in AF
The combination of traditional Chinese medicine (TCM) and warfarin is better than warfarin alone for the prevention of thromboembolic events in atrial fibrillation (AF) patients, according to a new meta-analysis.
Randomized controlled trials (RCTs) that compared TCM with warfarin vs warfarin alone in patients with persistent AF were searched from online databases. The outcomes of the studies were thromboembolic and bleeding events.
Information extracted from the studies included follow-up period, TCM and Western interventions, outcomes and AF parameters. The Cochrane risk of bias tool was used to assess methodological quality of the RCTs.
The search yielded nine RCTs corresponding to 905 AF patients. Of these, TCM alone was given to 221 patients, warfarin alone to 361 and TCM plus warfarin to 323. Insufficient reporting of randomization, blinding and concealment were common in the selected studies.
The five trials that compared warfarin alone against warfarin plus TCM showed that thromboembolic events occurred in only 2.71 percent of AF patients in the warfarin plus TCM group vs 8.94 percent in the warfarin alone group.
The risk of total thromboembolic events was significantly lower in patients who received TCM with warfarin than in those who received warfarin alone(risk ratio [RR], 0.32; 95 percent CI, 0.13 to 0.78; p=0.01).
Total bleeding events were reported in 4.44 percent of AF patients who received TCM plus warfarin 6.43 percent of patients who received warfarin alone. In contrast to total thromboembolic events, no significant difference in the risk of total bleeding events was reported (RR, 0.71; 0.29 to 1.72; p=0.45).