1. Real-world oral anticoagulants for Asian patients with non-valvular atrial fibrillation: A PRISMA-compliant article.
- Author
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Kim SM, Jeon ET, Jung JM, and Lee JS
- Subjects
- Anticoagulants pharmacology, Asian People statistics & numerical data, Humans, Outcome Assessment, Health Care, Atrial Fibrillation etiology, Atrial Fibrillation prevention & control, Factor Xa Inhibitors classification, Factor Xa Inhibitors pharmacology, Stroke complications, Stroke drug therapy, Warfarin pharmacology
- Abstract
Background and Purpose: This study aimed to evaluate the comparative efficacy and safety of 4 non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in Asians with non-valvular atrial fibrillation in real-world practice through a network meta-analysis of observational studies., Methods: We searched multiple comprehensive databases (PubMed, Embase, and Cochrane library) for studies published until August 2020. Hazard ratios and 95% confidence intervals were used for the pooled estimates. Efficacy outcomes included ischemic stroke (IS), stroke/systemic embolism (SSE), myocardial infarction (MI), and all-cause mortality, and safety outcomes included major bleeding, gastrointestinal (GI) bleeding, and intracerebral hemorrhage (ICH). The P score was calculated for ranking probabilities. Subgroup analyses were separately performed in accordance with the dosage range of NOACs ("standard-" and "low-dose")., Results: A total of 11, 6, and 8 studies were allocated to the total population, standard-dose group, and low-dose group, respectively. In the total study population, edoxaban ranked the best in terms of IS and ICH prevention and apixaban ranked the best for SSE, major bleeding, and GI bleeding. In the standard-dose regimen, apixaban ranked the best in terms of IS and SSE prevention. For major bleeding, GI bleeding, and ICH, edoxaban ranked the best. In the low-dose regimen, edoxaban ranked the best for IS, SSE, GI bleeding, and ICH prevention. For major bleeding prevention, apixaban ranked best., Conclusions: All 4 NOACs had different efficacy and safety outcomes according to their type and dosage. Apixaban and edoxaban might be relatively better and more well-balanced treatment for Asian patients with non-valvular atrial fibrillation., Competing Interests: The authors declare the following potential conflicts of interest concerning the research, authorship, and/or publication of this article. J-MJ has received the following: lecture honoraria from Pfizer, Sanofi-Aventis, Otsuka, Dong-A, and Hanmi Pharmaceutical Co., Ltd.; and consulting fees from Daewoong Pharmaceutical Co., Ltd. The authors declare that the research was conducted without any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2021
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