Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis
Abstract Introduction New oral anticoagulants (NOACs) are approved for use in nonvalvular atrial fibrillation (AF). Objectives This study aimed to evaluate the efficacy and safety of NOACs compared with warfarin in AF and valvular heart disease (VHD). Methods We identified randomized controlled tria...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Adis, Springer Healthcare
2019-05-01
|
Series: | Drugs in R&D |
Online Access: | http://link.springer.com/article/10.1007/s40268-019-0274-z |
id |
doaj-328d8c9dd2ef42369e2272ecbb91eece |
---|---|
record_format |
Article |
spelling |
doaj-328d8c9dd2ef42369e2272ecbb91eece2020-11-25T03:31:05ZengAdis, Springer HealthcareDrugs in R&D1174-58861179-69012019-05-0119211712610.1007/s40268-019-0274-zComparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-AnalysisYasmin de Souza Lima Bitar0Mansueto Gomes Neto1Jose Admirço Lima Filho2Larissa Vitória Pereira3Kethyren Santos Oliveira Travassos4Kevan M. Akrami5Leonardo Roever6Andre Rodrigues Duraes7Medical School of Federal University of Bahia, UFBA/FAMEBFederal University of Bahia, UFBAGeneral Hospital Roberto SantosFederal University of Bahia, UFBABahian School of Medicine and Public Health, BAHIANADepartment of Medicine, University of California San DiegoFederal University of UberlândiaMedical School of Federal University of Bahia, UFBA/FAMEBAbstract Introduction New oral anticoagulants (NOACs) are approved for use in nonvalvular atrial fibrillation (AF). Objectives This study aimed to evaluate the efficacy and safety of NOACs compared with warfarin in AF and valvular heart disease (VHD). Methods We identified randomized controlled trials (RCTs) and post-hoc analyses comparing NOACs and warfarin in AF and VHD, including biological and mechanical heart valves (MHV). Through systematic review and meta-analysis, with the aid of the “Rev Man” program 5.3, the primary effectiveness endpoints were stroke and systemic embolism (SE). The primary safety outcome was major bleeding, and the secondary outcome included intracranial hemorrhage. Data were analyzed using risk ratios (RRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using the I 2 statistic. Results Six RCTs were included, involving 13,850 patients with AF and VHD. NOACs significantly reduced the risk of stroke/SE (RR 0.78; 95% CI 0.66–0.91; P = 0.002) and intracranial hemorrhage (RR 0.51; 95% CI 0.33–0.79; P = 0.003) and lowered the risk of major bleeding (RR 0.77; 95% CI 0.58–1.02; P = 0.07) compared with warfarin. Conclusions The efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are similar to those of warfarin.http://link.springer.com/article/10.1007/s40268-019-0274-z |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yasmin de Souza Lima Bitar Mansueto Gomes Neto Jose Admirço Lima Filho Larissa Vitória Pereira Kethyren Santos Oliveira Travassos Kevan M. Akrami Leonardo Roever Andre Rodrigues Duraes |
spellingShingle |
Yasmin de Souza Lima Bitar Mansueto Gomes Neto Jose Admirço Lima Filho Larissa Vitória Pereira Kethyren Santos Oliveira Travassos Kevan M. Akrami Leonardo Roever Andre Rodrigues Duraes Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis Drugs in R&D |
author_facet |
Yasmin de Souza Lima Bitar Mansueto Gomes Neto Jose Admirço Lima Filho Larissa Vitória Pereira Kethyren Santos Oliveira Travassos Kevan M. Akrami Leonardo Roever Andre Rodrigues Duraes |
author_sort |
Yasmin de Souza Lima Bitar |
title |
Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis |
title_short |
Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis |
title_full |
Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis |
title_fullStr |
Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis |
title_full_unstemmed |
Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis |
title_sort |
comparison of the new oral anticoagulants and warfarin in patients with atrial fibrillation and valvular heart disease: systematic review and meta-analysis |
publisher |
Adis, Springer Healthcare |
series |
Drugs in R&D |
issn |
1174-5886 1179-6901 |
publishDate |
2019-05-01 |
description |
Abstract Introduction New oral anticoagulants (NOACs) are approved for use in nonvalvular atrial fibrillation (AF). Objectives This study aimed to evaluate the efficacy and safety of NOACs compared with warfarin in AF and valvular heart disease (VHD). Methods We identified randomized controlled trials (RCTs) and post-hoc analyses comparing NOACs and warfarin in AF and VHD, including biological and mechanical heart valves (MHV). Through systematic review and meta-analysis, with the aid of the “Rev Man” program 5.3, the primary effectiveness endpoints were stroke and systemic embolism (SE). The primary safety outcome was major bleeding, and the secondary outcome included intracranial hemorrhage. Data were analyzed using risk ratios (RRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using the I 2 statistic. Results Six RCTs were included, involving 13,850 patients with AF and VHD. NOACs significantly reduced the risk of stroke/SE (RR 0.78; 95% CI 0.66–0.91; P = 0.002) and intracranial hemorrhage (RR 0.51; 95% CI 0.33–0.79; P = 0.003) and lowered the risk of major bleeding (RR 0.77; 95% CI 0.58–1.02; P = 0.07) compared with warfarin. Conclusions The efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are similar to those of warfarin. |
url |
http://link.springer.com/article/10.1007/s40268-019-0274-z |
work_keys_str_mv |
AT yasmindesouzalimabitar comparisonoftheneworalanticoagulantsandwarfarininpatientswithatrialfibrillationandvalvularheartdiseasesystematicreviewandmetaanalysis AT mansuetogomesneto comparisonoftheneworalanticoagulantsandwarfarininpatientswithatrialfibrillationandvalvularheartdiseasesystematicreviewandmetaanalysis AT joseadmircolimafilho comparisonoftheneworalanticoagulantsandwarfarininpatientswithatrialfibrillationandvalvularheartdiseasesystematicreviewandmetaanalysis AT larissavitoriapereira comparisonoftheneworalanticoagulantsandwarfarininpatientswithatrialfibrillationandvalvularheartdiseasesystematicreviewandmetaanalysis AT kethyrensantosoliveiratravassos comparisonoftheneworalanticoagulantsandwarfarininpatientswithatrialfibrillationandvalvularheartdiseasesystematicreviewandmetaanalysis AT kevanmakrami comparisonoftheneworalanticoagulantsandwarfarininpatientswithatrialfibrillationandvalvularheartdiseasesystematicreviewandmetaanalysis AT leonardoroever comparisonoftheneworalanticoagulantsandwarfarininpatientswithatrialfibrillationandvalvularheartdiseasesystematicreviewandmetaanalysis AT andrerodriguesduraes comparisonoftheneworalanticoagulantsandwarfarininpatientswithatrialfibrillationandvalvularheartdiseasesystematicreviewandmetaanalysis |
_version_ |
1724573735748370432 |