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Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis

Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoin...

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Autores principales: Bonanad, Clara, García-Blas, Sergio, Torres Llergo, Javier, Fernández-Olmo, Rosa, Díez-Villanueva, Pablo, Ariza-Solé, Albert, Martínez-Sellés, Manuel, Raposeiras, Sergio, Ayesta, Ana, Bertomeu-González, Vicente, Tarazona Santabalbina, Francisco, Facila, Lorenzo, Vivas, David, Gabaldón-Pérez, Ana, Bodi, Vicente, Nuñez, Julio, Cordero, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618042/
https://www.ncbi.nlm.nih.gov/pubmed/34830548
http://dx.doi.org/10.3390/jcm10225268
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author Bonanad, Clara
García-Blas, Sergio
Torres Llergo, Javier
Fernández-Olmo, Rosa
Díez-Villanueva, Pablo
Ariza-Solé, Albert
Martínez-Sellés, Manuel
Raposeiras, Sergio
Ayesta, Ana
Bertomeu-González, Vicente
Tarazona Santabalbina, Francisco
Facila, Lorenzo
Vivas, David
Gabaldón-Pérez, Ana
Bodi, Vicente
Nuñez, Julio
Cordero, Alberto
author_facet Bonanad, Clara
García-Blas, Sergio
Torres Llergo, Javier
Fernández-Olmo, Rosa
Díez-Villanueva, Pablo
Ariza-Solé, Albert
Martínez-Sellés, Manuel
Raposeiras, Sergio
Ayesta, Ana
Bertomeu-González, Vicente
Tarazona Santabalbina, Francisco
Facila, Lorenzo
Vivas, David
Gabaldón-Pérez, Ana
Bodi, Vicente
Nuñez, Julio
Cordero, Alberto
author_sort Bonanad, Clara
collection PubMed
description Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63–0.82; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70–0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69–1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76–1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36–0.60; p < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF.
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spelling pubmed-86180422021-11-27 Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis Bonanad, Clara García-Blas, Sergio Torres Llergo, Javier Fernández-Olmo, Rosa Díez-Villanueva, Pablo Ariza-Solé, Albert Martínez-Sellés, Manuel Raposeiras, Sergio Ayesta, Ana Bertomeu-González, Vicente Tarazona Santabalbina, Francisco Facila, Lorenzo Vivas, David Gabaldón-Pérez, Ana Bodi, Vicente Nuñez, Julio Cordero, Alberto J Clin Med Review Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63–0.82; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70–0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69–1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76–1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36–0.60; p < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF. MDPI 2021-11-12 /pmc/articles/PMC8618042/ /pubmed/34830548 http://dx.doi.org/10.3390/jcm10225268 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Bonanad, Clara
García-Blas, Sergio
Torres Llergo, Javier
Fernández-Olmo, Rosa
Díez-Villanueva, Pablo
Ariza-Solé, Albert
Martínez-Sellés, Manuel
Raposeiras, Sergio
Ayesta, Ana
Bertomeu-González, Vicente
Tarazona Santabalbina, Francisco
Facila, Lorenzo
Vivas, David
Gabaldón-Pérez, Ana
Bodi, Vicente
Nuñez, Julio
Cordero, Alberto
Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_full Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_fullStr Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_full_unstemmed Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_short Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
title_sort direct oral anticoagulants versus warfarin in octogenarians with nonvalvular atrial fibrillation: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618042/
https://www.ncbi.nlm.nih.gov/pubmed/34830548
http://dx.doi.org/10.3390/jcm10225268
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