Direct comparison of non-vitamin K antagonist oral anticoagulant versus warfarin for stroke prevention in non-valvular atrial fibrillation: a systematic review and meta-analysis of real-world evidences

• Published in: The Egyptian heart journal Vol. 73; no. 1; p. 70
• Main Authors: Waranugraha, Yoga, Rizal, Ardian, Syaban, Mokhamad Fahmi Rizki, Faratisha, Icha Farihah Deniyati, Erwan, Nabila Erina, Yunita, Khadijah Cahya
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 11.08.2021; Springer; Springer Nature B.V; SpringerOpen
• Subjects: Anticoagulants; Anticoagulants (Medicine); Asia; Atrial fibrillation; Cardiology; Comparative analysis; Diet therapy; Drug dosages; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Meta-analysis; Mortality; Non-valvular atrial fibrillation; Non-vitamin K oral anticoagulant; Real-world study; Stroke; Stroke (Disease); Thromboembolism; Warfarin; Asia; United States > US; Warfarin; Real-world study; Non-vitamin K oral anticoagulant; Non-valvular atrial fibrillation; Meta-analysis
• ISSN: 2090-911X; 1110-2608; 2090-911X
• DOI: 10.1186/s43044-021-00194-1

Background To overcome the several drawbacks of warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were developed. Even though randomized controlled trials (RCTs) provided high-quality evidence, the real-world evidence is still needed. This systematic review and meta-analysis proposed to measure the safety and efficacy profile between warfarin and NOACs in non-valvular atrial fibrillation (NVAF) patients in preventing stroke. Results We collected articles about the real-world studies comparing warfarin and NOACs for NVAF patients recorded in electronic scientific databases such as Embase, ProQuest, PubMed, and Cochrane. The pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the generic inverse variance method. A total of 34 real-world studies, including 2287288 NVAF patients, were involved in this study. NOACs effectively reduced the stroke risk than warfarin (HR 0.77; 95% CI 0.69 to 0.87; p < 0.01). Moreover, NOACs effectively lowered all-cause mortality risk (HR 0.71; 95% CI 0.63 to 0.81; p < 0.01). From the safety aspect, compared to warfarin, NOACs significantly reduced major bleeding risk (HR 0.68; 95% CI 0.54 to 0.86; p < 0.01) and intracranial bleeding risk (HR 0.54; 95% CI 0.42 to 0.70; p < 0.01). However, NOACs administration failed to decrease gastrointestinal bleeding risk (HR 0.78; 95% CI 0.58 to 1.06; p = 0.12). Conclusions In NVAF patients, NOACs were found to be more effective than warfarin at reducing stroke risk. NOACSs also lowered the risk of all-cause mortality, cerebral hemorrhage, and severe bleeding in NVAF patients compared to warfarin.