Non-vitamin K antagonist oral anticoagulants have better efficacy and equivalent safety compared to warfarin in elderly patients with atrial fibrillation: A 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

12 Citations (Scopus)

Abstract

Background: To evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients (aged ≥75 years) with atrial fibrillation (AF), depending on dose and/or renal function. Methods: After systematically searching the databases (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), 5 phase III randomized controlled trials and reported data according to subgroups of elderly/non-elderly AF patients, comparing any NOACs and warfarin were included. The primary efficacy and safety outcomes were stroke/systemic thromboembolism and major bleeding. Results: (1) NOACs showed better efficacy than warfarin in elderly patients [RR 0.83 (0.69–1.00), p = 0.04, I2 = 55%], but equivalent efficacy in non-elderly patients. (2) NOACs reduced major bleeding compared to warfarin in non-elderly (p < 0.001) and had comparable safety to warfarin in elderly patients. (3) Even in elderly patients with moderately impaired renal function, NOACs had a safety profile comparable to that of warfarin for major bleeding if dose reduction was reached appropriately [pooled RR 0.82 (0.35–1.88), p = 0.63, I2 = 63%]. (4) All-cause mortality was lower with NOACs in non-elderly patients [RR 0.89 (0.83–0.95), p = 0.001, I2 = 0%], and with standard-dose NOAC group of elderly patients [RR 0.93 (0.86–1.00), p = 0.04, I2 = 0%] compared to warfarin. Conclusions: For elderly patients (aged ≥75 years), NOACs showed better efficacy and equivalent safety compared to warfarin even in those with moderately impaired renal function. All-cause mortality was lower with standard-dose NOACs compared to warfarin in the elderly patient group. Systematic review registration: The protocol of this meta-analysis was registered on PROSPERO under CRD42016047922 (https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016047922).

Original languageEnglish
Pages (from-to)105-112
Number of pages8
JournalJournal of Cardiology
Volume72
Issue number2
DOIs
Publication statusPublished - 2018 Aug

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Warfarin
Anticoagulants
Atrial Fibrillation
Meta-Analysis
Safety
Hemorrhage
Kidney
Vitamin K 1
Vitamin K 2
Mortality
Thromboembolism
Viperidae
Randomized Controlled Trials
Stroke
Databases

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{8bc602b4c38846d49e5adc35bd8d65cb,
title = "Non-vitamin K antagonist oral anticoagulants have better efficacy and equivalent safety compared to warfarin in elderly patients with atrial fibrillation: A systematic review and meta-analysis",
abstract = "Background: To evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients (aged ≥75 years) with atrial fibrillation (AF), depending on dose and/or renal function. Methods: After systematically searching the databases (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), 5 phase III randomized controlled trials and reported data according to subgroups of elderly/non-elderly AF patients, comparing any NOACs and warfarin were included. The primary efficacy and safety outcomes were stroke/systemic thromboembolism and major bleeding. Results: (1) NOACs showed better efficacy than warfarin in elderly patients [RR 0.83 (0.69–1.00), p = 0.04, I2 = 55{\%}], but equivalent efficacy in non-elderly patients. (2) NOACs reduced major bleeding compared to warfarin in non-elderly (p < 0.001) and had comparable safety to warfarin in elderly patients. (3) Even in elderly patients with moderately impaired renal function, NOACs had a safety profile comparable to that of warfarin for major bleeding if dose reduction was reached appropriately [pooled RR 0.82 (0.35–1.88), p = 0.63, I2 = 63{\%}]. (4) All-cause mortality was lower with NOACs in non-elderly patients [RR 0.89 (0.83–0.95), p = 0.001, I2 = 0{\%}], and with standard-dose NOAC group of elderly patients [RR 0.93 (0.86–1.00), p = 0.04, I2 = 0{\%}] compared to warfarin. Conclusions: For elderly patients (aged ≥75 years), NOACs showed better efficacy and equivalent safety compared to warfarin even in those with moderately impaired renal function. All-cause mortality was lower with standard-dose NOACs compared to warfarin in the elderly patient group. Systematic review registration: The protocol of this meta-analysis was registered on PROSPERO under CRD42016047922 (https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016047922).",
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 = "8",
doi = "10.1016/j.jjcc.2018.01.015",
language = "English",
volume = "72",
pages = "105--112",
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issn = "0914-5087",
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Non-vitamin K antagonist oral anticoagulants have better efficacy and equivalent safety compared to warfarin in elderly patients with atrial fibrillation : A 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. 2, 08.2018, p. 105-112.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Non-vitamin K antagonist oral anticoagulants have better efficacy and equivalent safety compared to warfarin in elderly patients with atrial fibrillation

T2 - A 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 - 2018/8

Y1 - 2018/8

N2 - Background: To evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients (aged ≥75 years) with atrial fibrillation (AF), depending on dose and/or renal function. Methods: After systematically searching the databases (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), 5 phase III randomized controlled trials and reported data according to subgroups of elderly/non-elderly AF patients, comparing any NOACs and warfarin were included. The primary efficacy and safety outcomes were stroke/systemic thromboembolism and major bleeding. Results: (1) NOACs showed better efficacy than warfarin in elderly patients [RR 0.83 (0.69–1.00), p = 0.04, I2 = 55%], but equivalent efficacy in non-elderly patients. (2) NOACs reduced major bleeding compared to warfarin in non-elderly (p < 0.001) and had comparable safety to warfarin in elderly patients. (3) Even in elderly patients with moderately impaired renal function, NOACs had a safety profile comparable to that of warfarin for major bleeding if dose reduction was reached appropriately [pooled RR 0.82 (0.35–1.88), p = 0.63, I2 = 63%]. (4) All-cause mortality was lower with NOACs in non-elderly patients [RR 0.89 (0.83–0.95), p = 0.001, I2 = 0%], and with standard-dose NOAC group of elderly patients [RR 0.93 (0.86–1.00), p = 0.04, I2 = 0%] compared to warfarin. Conclusions: For elderly patients (aged ≥75 years), NOACs showed better efficacy and equivalent safety compared to warfarin even in those with moderately impaired renal function. All-cause mortality was lower with standard-dose NOACs compared to warfarin in the elderly patient group. Systematic review registration: The protocol of this meta-analysis was registered on PROSPERO under CRD42016047922 (https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016047922).

AB - Background: To evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients (aged ≥75 years) with atrial fibrillation (AF), depending on dose and/or renal function. Methods: After systematically searching the databases (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), 5 phase III randomized controlled trials and reported data according to subgroups of elderly/non-elderly AF patients, comparing any NOACs and warfarin were included. The primary efficacy and safety outcomes were stroke/systemic thromboembolism and major bleeding. Results: (1) NOACs showed better efficacy than warfarin in elderly patients [RR 0.83 (0.69–1.00), p = 0.04, I2 = 55%], but equivalent efficacy in non-elderly patients. (2) NOACs reduced major bleeding compared to warfarin in non-elderly (p < 0.001) and had comparable safety to warfarin in elderly patients. (3) Even in elderly patients with moderately impaired renal function, NOACs had a safety profile comparable to that of warfarin for major bleeding if dose reduction was reached appropriately [pooled RR 0.82 (0.35–1.88), p = 0.63, I2 = 63%]. (4) All-cause mortality was lower with NOACs in non-elderly patients [RR 0.89 (0.83–0.95), p = 0.001, I2 = 0%], and with standard-dose NOAC group of elderly patients [RR 0.93 (0.86–1.00), p = 0.04, I2 = 0%] compared to warfarin. Conclusions: For elderly patients (aged ≥75 years), NOACs showed better efficacy and equivalent safety compared to warfarin even in those with moderately impaired renal function. All-cause mortality was lower with standard-dose NOACs compared to warfarin in the elderly patient group. Systematic review registration: The protocol of this meta-analysis was registered on PROSPERO under CRD42016047922 (https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016047922).

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JF - Journal of Cardiology

SN - 0914-5087

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