TY - JOUR
T1 - Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation
T2 - a systematic review and meta-regression analysis
AU - Bai, Ying
AU - Guo, Shi-Dong
AU - Deng, Hai
AU - Shantsila, Alena
AU - Fauchier, Laurent
AU - Ma, Chang-Sheng
AU - Lip, Gregory Y H
N1 - © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com
PY - 2018
Y1 - 2018
N2 - Background and objective: the study analysed the effectiveness and safety of warfarin use compared with warfarin non-use and non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients aged ≥65 years.Methods: after searching PubMed and the Cochrane Library, 26 studies were included, with 10 comparing warfarin with warfarin non-use and 16 comparing warfarin with NOACs, in older AF patients (≥65 years).Results: warfarin use was superior to no antithrombotic therapy [relative risk (RR) 0.59, 95% confidence interval (CI) 0.51-0.76, I2 = 12.3%, n = 8] and aspirin (RR 0.44, 95% CI 0.24-0.64, I2 = 0.0%, n = 5) for stroke/thromboembolism (TE) prevention. Warfarin use was associated with a non-significant increase in risk of major bleeding compared with no antithrombotic therapy (RR 1.26, 95% CI 0.99-1.52, I2 = 0.0%, n = 7) and aspirin (RR 1.20, 95% CI 0.91-1.50, I2 = 0.0%, n = 5). NOACs were superior to warfarin for stroke/TE prevention [hazard ratio (HR) 0.81, 95% CI 0.73-0.89, I2 = 56.6%, n = 9], and also were associated with reduced risk of major bleeding compared to warfarin (HR 0.87, 0.77-0.97, I2 = 86.1%, n = 9).Conclusions: warfarin use was superior to warfarin non-use, aspirin and no antithrombotic therapy in reducing the risk of stroke/TE in older AF patients, but with a possible increase in major bleeding. NOACs were superior to warfarin for stroke/TE prevention, with reduced risk of major bleeding.
AB - Background and objective: the study analysed the effectiveness and safety of warfarin use compared with warfarin non-use and non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients aged ≥65 years.Methods: after searching PubMed and the Cochrane Library, 26 studies were included, with 10 comparing warfarin with warfarin non-use and 16 comparing warfarin with NOACs, in older AF patients (≥65 years).Results: warfarin use was superior to no antithrombotic therapy [relative risk (RR) 0.59, 95% confidence interval (CI) 0.51-0.76, I2 = 12.3%, n = 8] and aspirin (RR 0.44, 95% CI 0.24-0.64, I2 = 0.0%, n = 5) for stroke/thromboembolism (TE) prevention. Warfarin use was associated with a non-significant increase in risk of major bleeding compared with no antithrombotic therapy (RR 1.26, 95% CI 0.99-1.52, I2 = 0.0%, n = 7) and aspirin (RR 1.20, 95% CI 0.91-1.50, I2 = 0.0%, n = 5). NOACs were superior to warfarin for stroke/TE prevention [hazard ratio (HR) 0.81, 95% CI 0.73-0.89, I2 = 56.6%, n = 9], and also were associated with reduced risk of major bleeding compared to warfarin (HR 0.87, 0.77-0.97, I2 = 86.1%, n = 9).Conclusions: warfarin use was superior to warfarin non-use, aspirin and no antithrombotic therapy in reducing the risk of stroke/TE in older AF patients, but with a possible increase in major bleeding. NOACs were superior to warfarin for stroke/TE prevention, with reduced risk of major bleeding.
KW - Journal Article
KW - Non-vitamin K anticoagulant agents
KW - Atrial fibrillation
KW - Older people
KW - Warfarin non-use
KW - Warfarin use
KW - Systematic review
KW - Stroke/diagnosis
KW - Age Factors
KW - Administration, Oral
KW - Humans
KW - Risk Factors
KW - Male
KW - Treatment Outcome
KW - Warfarin/administration & dosage
KW - Hemorrhage/chemically induced
KW - Anticoagulants/administration & dosage
KW - Time Factors
KW - Patient Safety
KW - Female
KW - Thromboembolism/diagnosis
KW - Aged
KW - Atrial Fibrillation/diagnosis
KW - Odds Ratio
UR - http://www.scopus.com/inward/record.url?scp=85040539006&partnerID=8YFLogxK
U2 - 10.1093/ageing/afx103
DO - 10.1093/ageing/afx103
M3 - Review article
C2 - 28985259
SN - 0002-0729
VL - 47
SP - 9
EP - 17
JO - Age and Ageing
JF - Age and Ageing
IS - 1
ER -