Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation: Systematic review and meta-analysis

In Soo Kim; Hyun Jung Kim; Tae Hoon Kim; Jae Sun Uhm; Boyoung Joung; Moon Hyoung Lee; Hui Nam Pak

doi:10.1016/j.jjcc.2018.03.009

Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation: Systematic review and meta-analysis

In Soo Kim, Hyun Jung Kim, Tae Hoon Kim, Jae Sun Uhm, Boyoung Joung, Moon Hyoung Lee, Hui Nam Pak

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Background: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in “atrial fibrillation (AF) patients who were OAC-naïve,” or “AF patients with prior-stroke history” with those who were known to be high-risk subgroups under OAC. Methods: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in “OAC-naïve/OAC-experienced,” or “with/without prior-stroke history” subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. Results: 1. In OAC-naïve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84–0.97), p = 0.008, I² = 0%] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40–0.91), p = 0.02, I² = 89%], and had lower all-cause mortality [RR 0.86 (0.75–0.99), p = 0.04, I² = 38%] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48–0.70), p < 0.001, I² = 0%] and all-cause mortality [RR 0.76 (0.66–0.88), p < 0.001, I² = 0%] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66–0.91), p = 0.002, I² = 43%] and all-cause mortality [RR 0.91 (0.85–0.97), p = 0.004, I² = 0%]. Conclusions: In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-naïve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality.

Original language	English
Pages (from-to)	284-291
Number of pages	8
Journal	Journal of Cardiology
Volume	72
Issue number	4
DOIs	https://doi.org/10.1016/j.jjcc.2018.03.009
Publication status	Published - 2018 Oct

Bibliographical note

Funding Information:
This research was supported by a grant (A085136) from the Korea Health 21 R&D Project, which is funded by the Ministry of Health and Welfare, and by a grant [NRF-2017R1A2B4003983] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP).

Funding Information:
This research was supported by a grant ( A085136 ) from the Korea Health 21 R&D Project, which is funded by the Ministry of Health and Welfare , and by a grant [ NRF-2017R1A2B4003983 ] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP) .

Publisher Copyright:
© 2018 Japanese College of Cardiology

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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10.1016/j.jjcc.2018.03.009

Cite this

@article{8671711c9b184bddb01457124f08c372,

title = "Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation: Systematic review and meta-analysis",

abstract = "Background: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in “atrial fibrillation (AF) patients who were OAC-na{\"i}ve,” or “AF patients with prior-stroke history” with those who were known to be high-risk subgroups under OAC. Methods: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in “OAC-na{\"i}ve/OAC-experienced,” or “with/without prior-stroke history” subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. Results: 1. In OAC-na{\"i}ve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84–0.97), p = 0.008, I2 = 0%] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40–0.91), p = 0.02, I2 = 89%], and had lower all-cause mortality [RR 0.86 (0.75–0.99), p = 0.04, I2 = 38%] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48–0.70), p < 0.001, I2 = 0%] and all-cause mortality [RR 0.76 (0.66–0.88), p < 0.001, I2 = 0%] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66–0.91), p = 0.002, I2 = 43%] and all-cause mortality [RR 0.91 (0.85–0.97), p = 0.004, I2 = 0%]. Conclusions: In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-na{\"i}ve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality.",

author = "Kim, {In Soo} and Kim, {Hyun Jung} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Boyoung Joung and Lee, {Moon Hyoung} and Pak, {Hui Nam}",

note = "Funding Information: This research was supported by a grant (A085136) from the Korea Health 21 R&D Project, which is funded by the Ministry of Health and Welfare, and by a grant [NRF-2017R1A2B4003983] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP). Funding Information: This research was supported by a grant ( A085136 ) from the Korea Health 21 R&D Project, which is funded by the Ministry of Health and Welfare , and by a grant [ NRF-2017R1A2B4003983 ] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP) . Publisher Copyright: {\textcopyright} 2018 Japanese College of Cardiology",

year = "2018",

month = oct,

doi = "10.1016/j.jjcc.2018.03.009",

language = "English",

volume = "72",

pages = "284--291",

journal = "Journal of Cardiology",

issn = "0914-5087",

number = "4",

}

TY - JOUR

T1 - Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation

T2 - Systematic review and meta-analysis

AU - Kim, In Soo

AU - Kim, Hyun Jung

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Joung, Boyoung

AU - Lee, Moon Hyoung

AU - Pak, Hui Nam

N1 - Funding Information: This research was supported by a grant (A085136) from the Korea Health 21 R&D Project, which is funded by the Ministry of Health and Welfare, and by a grant [NRF-2017R1A2B4003983] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP). Funding Information: This research was supported by a grant ( A085136 ) from the Korea Health 21 R&D Project, which is funded by the Ministry of Health and Welfare , and by a grant [ NRF-2017R1A2B4003983 ] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP) . Publisher Copyright: © 2018 Japanese College of Cardiology

PY - 2018/10

Y1 - 2018/10

N2 - Background: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in “atrial fibrillation (AF) patients who were OAC-naïve,” or “AF patients with prior-stroke history” with those who were known to be high-risk subgroups under OAC. Methods: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in “OAC-naïve/OAC-experienced,” or “with/without prior-stroke history” subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. Results: 1. In OAC-naïve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84–0.97), p = 0.008, I2 = 0%] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40–0.91), p = 0.02, I2 = 89%], and had lower all-cause mortality [RR 0.86 (0.75–0.99), p = 0.04, I2 = 38%] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48–0.70), p < 0.001, I2 = 0%] and all-cause mortality [RR 0.76 (0.66–0.88), p < 0.001, I2 = 0%] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66–0.91), p = 0.002, I2 = 43%] and all-cause mortality [RR 0.91 (0.85–0.97), p = 0.004, I2 = 0%]. Conclusions: In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-naïve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality.

AB - Background: We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in “atrial fibrillation (AF) patients who were OAC-naïve,” or “AF patients with prior-stroke history” with those who were known to be high-risk subgroups under OAC. Methods: After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in “OAC-naïve/OAC-experienced,” or “with/without prior-stroke history” subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. Results: 1. In OAC-naïve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84–0.97), p = 0.008, I2 = 0%] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40–0.91), p = 0.02, I2 = 89%], and had lower all-cause mortality [RR 0.86 (0.75–0.99), p = 0.04, I2 = 38%] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48–0.70), p < 0.001, I2 = 0%] and all-cause mortality [RR 0.76 (0.66–0.88), p < 0.001, I2 = 0%] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66–0.91), p = 0.002, I2 = 43%] and all-cause mortality [RR 0.91 (0.85–0.97), p = 0.004, I2 = 0%]. Conclusions: In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-naïve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality.

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ER -

Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation: Systematic review and meta-analysis

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