Comparing clinical outcomes of NOACs with warfarin on atrial fibrillation with Valvular heart diseases: a meta-analysis

• Published in: BMC cardiovascular disorders 2019-05, Vol.19 (1), p.113-113, Article 113
• Main Authors: He, Qiyu, Sze, Chun-Yat, Shum, Tin-Yau, Hao, Guang, Wong, Nga-Yin Belinda, Sin, Tat-Hang, Wei, Wei, Xia, Sujian
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Analysis; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Aortic valve; Apixaban; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - etiology; Atrial Fibrillation - mortality; Bleeding; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular diseases; Clinical outcomes; Comparative analysis; Coronary artery disease; Disease prevention; Drug therapy; Editorials; Female; Fibrillation; Heart; Heart diseases; Heart valve diseases; Heart Valve Diseases - complications; Heart Valve Diseases - diagnosis; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - adverse effects; Hemorrhage - chemically induced; Human subjects; Humans; Intervention; Male; Meta-analysis; Middle Aged; Mortality; NOAC; Novels; Prostheses; Public access; Risk Assessment; Risk Factors; Rivaroxaban; Stroke; Stroke - diagnosis; Stroke - etiology; Stroke - mortality; Stroke - prevention & control; Studies; Systematic review; Thromboembolism; Thrombosis; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome; Valvular heart disease; Warfarin; Warfarin - administration & dosage; Warfarin - adverse effects
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-019-1089-0

Warfarin is the standard of care and NOAC (Novel oral anticoagulants) are a group of newer drugs for such purposes. NOAC has a generally better profile (Clear interaction, less side effect, require less monitoring). However, its efficacy on valvular atrial fibrillation remains unclear. We researched literature articles from Embase, Cochrane and PubMed. Then we meta-analysed these six articles to assess pooled estimate of relative risk (RR) and 95% confidence intervals (Cl) using random-effects model for stroke, systemic embolic event, major bleeding and all-cause mortality. Heterogeneity across study was tested with Cochran's Q Test and I Test. The bias of studies was first tested by examining the symmetry of Funnel Plot. Cochrane's Collaboration Tool was also used to report any presented bias. We collected 496 articles in total and finally we included six articles in our meta-analysis. For SSEE (Stroke, Systemic Embolic Event), the pooled relative risk showed a significantly better clinical outcome of NOAC (RR: 0.66; 95% CI: 0.46 to 0.95). However, there is no significant difference in major bleeding (RR: 0.714, 95% CI:0.46 to 1.11) and all-cause mortality (RR: 0.84, 95% CI: 0.58 to 1.21). Compared to Warfarin, NOAC is significantly more protective against the embolic event, but no significant difference in lowering risk of major bleeding, all-cause mortality or all aspects of post-TAVI (Trans-catheter aortic valve implantation).