Efficacy and Safety of Oral Anticoagulants in Older Adult Patients With Atrial Fibrillation: Pairwise and Network Meta-Analyses |
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| Affiliation: | 1. National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China;2. Graduate School, Beijing University of Chinese Medicine, Beijing, China;1. International Center for Epilepsy, St. Bernard Parish Medical Center, New Orleans, LA, USA;2. Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA;3. Comprehensive Epilepsy Center, New York University, New York, NY, USA;4. Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA;5. Neurelis, Inc, San Diego, CA, USA;6. John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA;1. New York University Rory Meyers College of Nursing, New York, NY, USA;2. Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA;3. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;4. Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA;5. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;1. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA;2. Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA;3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA;4. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA |
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| Abstract: | ObjectiveTo evaluate the efficacy and safety of oral anticoagulants for older adult patients with atrial fibrillation (AF).DesignPairwise and network meta-analyses.Setting and ParticipantsPatients with AF aged ≥75 years.MethodsPubMed, Embase, and the Cochrane library were searched for published randomized controlled trials and adjusted observational studies evaluating the use of a non–vitamin K antagonist oral anticoagulants (NOACs), vitamin K antagonist, or antiplatelet drug for the prevention of stroke. The primary efficacy and safety outcomes were the composite of stroke and systemic embolism (SSE) and major bleedings.ResultsThis study included 38 studies enrolling 1,022,908 older adult patients with AF. Results from pairwise meta-analyses showed that NOACs were superior to warfarin for all outcomes, except that dabigatran increased the risk of gastrointestinal (GI) bleedings. Aspirin was associated with a higher risk of SSE and ischemic stroke than warfarin or NOACs. Results of network meta-analyses indicated that apixaban significantly reduced the risk of SSE, major bleedings, and GI bleedings than warfarin, rivaroxaban, and dabigatran. Apixaban, edoxaban, rivaroxaban, and dabigatran reduced the risk of ischemic stroke and intracranial bleeding compared to warfarin. Dabigatran showed lower risk of all-cause mortality than warfarin and of intracranial bleeding than rivaroxaban.Conclusions and ImplicationsNOACs are of at least equal efficacy, or even superior to warfarin. The safety profile of individual NOAC agents was significantly different, as apixaban performs better than the other oral anticoagulants in reducing major bleeding and GI bleeding, whereas dabigatran increased the risk of GI bleeding. |
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| Keywords: | Atrial fibrillation older adult non–vitamin K antagonist oral anticoagulants warfarin meta-analysis |
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