Elderly Bleeding Risk of Direct Oral Anticoagulants in Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Cohort Studies

Introduction The 2014 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) guidelines recommend anticoagulation to reduce clot formation and the risk of thromboembolic events in patients with atrial fibrillation but does not specify guidelines for the elde...

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Bibliographic Details
Published in:Drugs in R&D 2019-09, Vol.19 (3), p.235-245
Main Authors: Lobraico-Fernandez, Jessika, Baksh, Salma, Nemec, Eric
Format: Article
Language:English
Subjects:
Administration, Oral
Anticoagulants
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
Atrial Fibrillation - drug therapy
Cardiac arrhythmia
Cohort analysis
Cohort Studies
Health risk assessment
Hemorrhage - chemically induced
Humans
Internal Medicine
Medicine
Medicine & Public Health
Meta-analysis
Older people
Pharmacology/Toxicology
Pharmacotherapy
Systematic Review
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Summary:Introduction The 2014 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) guidelines recommend anticoagulation to reduce clot formation and the risk of thromboembolic events in patients with atrial fibrillation but does not specify guidelines for the elderly population. Direct oral anticoagulants (DOACs) are newer US FDA-approved alternatives to warfarin and include dabigatran, rivaroxaban, apixaban and edoxaban. The efficacy of DOACs is heavily researched, but few studies have evaluated their bleeding risk. Objectives This systematic review and meta-analysis investigates which DOAC has the lowest bleeding risk in elderly patients with nonvalvular atrial fibrillation (NVAF). Methods CINAHL and MEDLINE databases were searched using specific keywords, and 244 results were identified and screened. Inclusion criteria required a major bleeding event requiring hospitalization as an outcome and excluded patients with severe renal failure. Articles that met inclusion criteria were assessed for risk of bias using the Cochrane Tool to Assess Risk of Bias in Cohort Studies. Review Manager (version 5) was used to perform the random-effects model meta-analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. P  
ISSN:1174-5886
1179-6901
DOI:10.1007/s40268-019-0275-y