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

• Main Authors: Qiyu He, Chun-Yat Sze, Tin-Yau Shum, Guang Hao, Nga-Yin Belinda Wong, Tat-Hang Sin, Wei Wei, Sujian Xia
• Format: Article
• Language: English
• Published: BMC 2019-05-01
• Series: BMC Cardiovascular Disorders
• Subjects: Meta-analysis; NOAC; Warfarin; Atrial fibrillation; Valvular heart disease
• Online Access: http://link.springer.com/article/10.1186/s12872-019-1089-0

Abstract Background 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. Method 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 I2 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. Results 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). Conclusion 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).