Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation: Systematic review and meta-analysis

In Soo Kim, Hyun Jung Kim, Tae Hoon Kim, Jae Sun Uhm, Boyoung Joung, Moon Hyoung Lee, Hui Nam Pak

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in “atrial fibrillation (AF) patients who were OAC-naïve,” or “AF patients with prior-stroke history” with those who were known to be high-risk subgroups under OAC. Methods: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in “OAC-naïve/OAC-experienced,” or “with/without prior-stroke history” subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. Results: 1. In OAC-naïve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84–0.97), p = 0.008, I2 = 0%] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40–0.91), p = 0.02, I2 = 89%], and had lower all-cause mortality [RR 0.86 (0.75–0.99), p = 0.04, I2 = 38%] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48–0.70), p < 0.001, I2 = 0%] and all-cause mortality [RR 0.76 (0.66–0.88), p < 0.001, I2 = 0%] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66–0.91), p = 0.002, I2 = 43%] and all-cause mortality [RR 0.91 (0.85–0.97), p = 0.004, I2 = 0%]. Conclusions: In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-naïve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality.

Original languageEnglish
Pages (from-to)284-291
Number of pages8
JournalJournal of Cardiology
Volume72
Issue number4
DOIs
Publication statusPublished - 2018 Oct

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Anticoagulants
Atrial Fibrillation
Meta-Analysis
Warfarin
Stroke
Mortality
Thromboembolism
Hemorrhage
Safety
Intracranial Hemorrhages
Databases

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{8671711c9b184bddb01457124f08c372,
title = "Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation: Systematic review and meta-analysis",
abstract = "Background: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in “atrial fibrillation (AF) patients who were OAC-na{\"i}ve,” or “AF patients with prior-stroke history” with those who were known to be high-risk subgroups under OAC. Methods: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in “OAC-na{\"i}ve/OAC-experienced,” or “with/without prior-stroke history” subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. Results: 1. In OAC-na{\"i}ve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84–0.97), p = 0.008, I2 = 0{\%}] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40–0.91), p = 0.02, I2 = 89{\%}], and had lower all-cause mortality [RR 0.86 (0.75–0.99), p = 0.04, I2 = 38{\%}] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48–0.70), p < 0.001, I2 = 0{\%}] and all-cause mortality [RR 0.76 (0.66–0.88), p < 0.001, I2 = 0{\%}] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66–0.91), p = 0.002, I2 = 43{\%}] and all-cause mortality [RR 0.91 (0.85–0.97), p = 0.004, I2 = 0{\%}]. Conclusions: In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-na{\"i}ve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality.",
author = "Kim, {In Soo} and Kim, {Hyun Jung} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Boyoung Joung and Lee, {Moon Hyoung} and Pak, {Hui Nam}",
year = "2018",
month = "10",
doi = "10.1016/j.jjcc.2018.03.009",
language = "English",
volume = "72",
pages = "284--291",
journal = "Journal of Cardiology",
issn = "0914-5087",
number = "4",

}

Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation : Systematic review and meta-analysis. / Kim, In Soo; Kim, Hyun Jung; Kim, Tae Hoon; Uhm, Jae Sun; Joung, Boyoung; Lee, Moon Hyoung; Pak, Hui Nam.

In: Journal of Cardiology, Vol. 72, No. 4, 10.2018, p. 284-291.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation

T2 - Systematic review and meta-analysis

AU - Kim, In Soo

AU - Kim, Hyun Jung

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Joung, Boyoung

AU - Lee, Moon Hyoung

AU - Pak, Hui Nam

PY - 2018/10

Y1 - 2018/10

N2 - Background: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in “atrial fibrillation (AF) patients who were OAC-naïve,” or “AF patients with prior-stroke history” with those who were known to be high-risk subgroups under OAC. Methods: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in “OAC-naïve/OAC-experienced,” or “with/without prior-stroke history” subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. Results: 1. In OAC-naïve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84–0.97), p = 0.008, I2 = 0%] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40–0.91), p = 0.02, I2 = 89%], and had lower all-cause mortality [RR 0.86 (0.75–0.99), p = 0.04, I2 = 38%] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48–0.70), p < 0.001, I2 = 0%] and all-cause mortality [RR 0.76 (0.66–0.88), p < 0.001, I2 = 0%] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66–0.91), p = 0.002, I2 = 43%] and all-cause mortality [RR 0.91 (0.85–0.97), p = 0.004, I2 = 0%]. Conclusions: In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-naïve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality.

AB - Background: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in “atrial fibrillation (AF) patients who were OAC-naïve,” or “AF patients with prior-stroke history” with those who were known to be high-risk subgroups under OAC. Methods: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in “OAC-naïve/OAC-experienced,” or “with/without prior-stroke history” subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. Results: 1. In OAC-naïve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84–0.97), p = 0.008, I2 = 0%] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40–0.91), p = 0.02, I2 = 89%], and had lower all-cause mortality [RR 0.86 (0.75–0.99), p = 0.04, I2 = 38%] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48–0.70), p < 0.001, I2 = 0%] and all-cause mortality [RR 0.76 (0.66–0.88), p < 0.001, I2 = 0%] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66–0.91), p = 0.002, I2 = 43%] and all-cause mortality [RR 0.91 (0.85–0.97), p = 0.004, I2 = 0%]. Conclusions: In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-naïve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality.

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DO - 10.1016/j.jjcc.2018.03.009

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JO - Journal of Cardiology

JF - Journal of Cardiology

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