Cargando…
Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis
BACKGROUND: The meta-analysis of randomized controlled trials has illustrated that the efficacy of low-dose non-vitamin K antagonist oral anticoagulants is inferior compared with standard-dose non-vitamin K antagonist oral anticoagulants, though they are still frequently prescribed for Asian patient...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Turkish Society of Cardiology
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9361199/ https://www.ncbi.nlm.nih.gov/pubmed/35703478 http://dx.doi.org/10.5152/AnatolJCardiol.2022.1376 |
_version_ | 1784764478809702400 |
---|---|
author | Li, Ze Zheng, Yingming Li, Dandan Wang, Xiaozhen Cheng, Sheng Luo, Xiao Wen, Aiping |
author_facet | Li, Ze Zheng, Yingming Li, Dandan Wang, Xiaozhen Cheng, Sheng Luo, Xiao Wen, Aiping |
author_sort | Li, Ze |
collection | PubMed |
description | BACKGROUND: The meta-analysis of randomized controlled trials has illustrated that the efficacy of low-dose non-vitamin K antagonist oral anticoagulants is inferior compared with standard-dose non-vitamin K antagonist oral anticoagulants, though they are still frequently prescribed for Asian patients with non-valvular atrial fibrillation. We aimed to further investigate the efficacy and safety of low-dose non-vitamin K antagonist oral anticoagulants by carrying out a meta-analysis of all relevant randomized controlled trials and cohort studies. METHODS: Cochrane Central Register of Controlled Trials, Embase, and MEDLINE were systematically searched from the inception to September 9, 2021, for randomized controlled trials or cohorts that compared the efficacy and/or safety of low-dose non-vitamin K antagonist oral anticoagulants in Asian patients with non-valvular atrial fibrillation. The primary outcomes were stroke and major bleeding, and the secondary outcomes were mortality, intracranial hemorrhage, and gastrointestinal hemorrhage. Hazard ratios and 95% CIs were estimated using the random-effect model. RESULTS: Nineteen publications involving 371 574 Asian patients with non-valvular atrial fibrillation were included. Compared with standard-dose non-vitamin K antagonist oral anticoagulants, low-dose non-vitamin K antagonist oral anticoagulants showed comparable risks of stroke (hazard ratio, 1.18; 95% CI 0.98 to 1.42), major bleeding (hazard ratio, 1.00; 95% CI 0.83 to 1.21), intracranial hemorrhage (hazard ratio, 1.13; 95% CI 0.92 to 1.38), and gastrointestinal hemorrhage (hazard ratio, 1.07; 95% CI 0.87 to 1.31), though had a higher risk of mortality (hazard ratio, 1.34; 95% CI 1.05 to 1.71). Compared with warfarin, low-dose non-vitamin K antagonist oral anticoagulants were associated with lower risks of stroke (hazard ratio, 0.73; 95% CI 0.67 to 0.79), mortality (hazard ratio, 0.69; 95% CI 0.60 to 0.81), major bleeding (hazard ratio, 0.62; 95% CI 0.51 to 0.75), intracranial hemorrhage (hazard ratio, 0.48; 95% CI 0.33 to 0.69), and gastrointestinal hemorrhage (hazard ratio, 0.78; 95% CI 0.65 to 0.93). CONCLUSION: Low-dose non-vitamin K antagonist oral anticoagulants were superior to warfarin, and comparable to standard-dose non-vitamin K antagonist oral anticoagulants considering risks of stroke, major bleeding, intracranial hemorrhage, and gastrointestinal hemorrhage. Further, high qualified studies are warranted. |
format | Online Article Text |
id | pubmed-9361199 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Turkish Society of Cardiology |
record_format | MEDLINE/PubMed |
spelling | pubmed-93611992022-08-15 Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis Li, Ze Zheng, Yingming Li, Dandan Wang, Xiaozhen Cheng, Sheng Luo, Xiao Wen, Aiping Anatol J Cardiol Meta-Analysis BACKGROUND: The meta-analysis of randomized controlled trials has illustrated that the efficacy of low-dose non-vitamin K antagonist oral anticoagulants is inferior compared with standard-dose non-vitamin K antagonist oral anticoagulants, though they are still frequently prescribed for Asian patients with non-valvular atrial fibrillation. We aimed to further investigate the efficacy and safety of low-dose non-vitamin K antagonist oral anticoagulants by carrying out a meta-analysis of all relevant randomized controlled trials and cohort studies. METHODS: Cochrane Central Register of Controlled Trials, Embase, and MEDLINE were systematically searched from the inception to September 9, 2021, for randomized controlled trials or cohorts that compared the efficacy and/or safety of low-dose non-vitamin K antagonist oral anticoagulants in Asian patients with non-valvular atrial fibrillation. The primary outcomes were stroke and major bleeding, and the secondary outcomes were mortality, intracranial hemorrhage, and gastrointestinal hemorrhage. Hazard ratios and 95% CIs were estimated using the random-effect model. RESULTS: Nineteen publications involving 371 574 Asian patients with non-valvular atrial fibrillation were included. Compared with standard-dose non-vitamin K antagonist oral anticoagulants, low-dose non-vitamin K antagonist oral anticoagulants showed comparable risks of stroke (hazard ratio, 1.18; 95% CI 0.98 to 1.42), major bleeding (hazard ratio, 1.00; 95% CI 0.83 to 1.21), intracranial hemorrhage (hazard ratio, 1.13; 95% CI 0.92 to 1.38), and gastrointestinal hemorrhage (hazard ratio, 1.07; 95% CI 0.87 to 1.31), though had a higher risk of mortality (hazard ratio, 1.34; 95% CI 1.05 to 1.71). Compared with warfarin, low-dose non-vitamin K antagonist oral anticoagulants were associated with lower risks of stroke (hazard ratio, 0.73; 95% CI 0.67 to 0.79), mortality (hazard ratio, 0.69; 95% CI 0.60 to 0.81), major bleeding (hazard ratio, 0.62; 95% CI 0.51 to 0.75), intracranial hemorrhage (hazard ratio, 0.48; 95% CI 0.33 to 0.69), and gastrointestinal hemorrhage (hazard ratio, 0.78; 95% CI 0.65 to 0.93). CONCLUSION: Low-dose non-vitamin K antagonist oral anticoagulants were superior to warfarin, and comparable to standard-dose non-vitamin K antagonist oral anticoagulants considering risks of stroke, major bleeding, intracranial hemorrhage, and gastrointestinal hemorrhage. Further, high qualified studies are warranted. Turkish Society of Cardiology 2022-06-01 /pmc/articles/PMC9361199/ /pubmed/35703478 http://dx.doi.org/10.5152/AnatolJCardiol.2022.1376 Text en © Copyright 2022 authors https://creativecommons.org/licenses/by-nc/4.0/ Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. (https://creativecommons.org/licenses/by-nc/4.0/) |
spellingShingle | Meta-Analysis Li, Ze Zheng, Yingming Li, Dandan Wang, Xiaozhen Cheng, Sheng Luo, Xiao Wen, Aiping Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis |
title | Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis |
title_full | Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis |
title_fullStr | Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis |
title_full_unstemmed | Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis |
title_short | Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis |
title_sort | low-dose noacs versus standard-dose noacs or warfarin on efficacy and safety in asian patients with nvaf: a meta-analysis |
topic | Meta-Analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9361199/ https://www.ncbi.nlm.nih.gov/pubmed/35703478 http://dx.doi.org/10.5152/AnatolJCardiol.2022.1376 |
work_keys_str_mv | AT lize lowdosenoacsversusstandarddosenoacsorwarfarinonefficacyandsafetyinasianpatientswithnvafametaanalysis AT zhengyingming lowdosenoacsversusstandarddosenoacsorwarfarinonefficacyandsafetyinasianpatientswithnvafametaanalysis AT lidandan lowdosenoacsversusstandarddosenoacsorwarfarinonefficacyandsafetyinasianpatientswithnvafametaanalysis AT wangxiaozhen lowdosenoacsversusstandarddosenoacsorwarfarinonefficacyandsafetyinasianpatientswithnvafametaanalysis AT chengsheng lowdosenoacsversusstandarddosenoacsorwarfarinonefficacyandsafetyinasianpatientswithnvafametaanalysis AT luoxiao lowdosenoacsversusstandarddosenoacsorwarfarinonefficacyandsafetyinasianpatientswithnvafametaanalysis AT wenaiping lowdosenoacsversusstandarddosenoacsorwarfarinonefficacyandsafetyinasianpatientswithnvafametaanalysis |