Key result
Apixaban reduced stroke/systemic embolism (HR 0.72; 95% CrI 0.59-0.96) and edoxaban reduced major bleeding (HR 0.66; 95% CrI 0.50-0.92) compared with VKAs in AF patients at risk of falls.
Why the study?
DOACs are preferred over VKAs for AF, but AF patients with a history or risk of falls seldom receive anticoagulants due to bleeding risk.
Do DOACs reduce stroke/systemic embolism and major bleeding compared to VKAs in patients with atrial fibrillation and a history or risk of falls?
Meta-Analysis
Do DOACs reduce stroke/systemic embolism and major bleeding compared to VKAs in patients with atrial fibrillation and a history or risk of falls?
In AF patients at risk of falls, DOACs are preferable to VKAs, with apixaban showing the best efficacy for stroke prevention and edoxaban showing the best safety for major bleeding.
Answers are grounded in this paper and cite their sources.
Favors apixaban for stroke prevention and edoxaban for bleeding reduction over VKAs in fall-risk AF; extends network evidence to this subgroup.
PURPOSE: Non-vitamin K antagonist oral anticoagulants (DOACs) are the preferred treatment over vitamin K antagonists (VKAs) for patients with atrial fibrillation (AF). However, AF patients at risk or with history of falls seldom receive anticoagulants due to the bleeding risk. The objective was to assess the efficacy and safety of DOACs in AF patients with history or risk of falls. METHODS: A systematic literature review was conducted until October 31, 2024. Primary outcomes were stroke/systemic embolism (SSE) and major bleeding (MB). Bayesian network meta-analyses were conducted. Hazard ratios (HRs) with 95% credible intervals (CrI) quantified the effect of drugs; cumulative ranking curves (SUCRA) were used to determine their hierarchy. RESULTS: Out of 961 articles, 10 articles (5 randomized controlled trials and 5 observational studies) were retained for quantitative synthesis. Risk of bias was moderate to serious. In reducing the risk of SSE compared with VKAs, apixaban had a SUCRA of 0.87 (HR 0.72, 95% CrI 0.59-0.96), followed by rivaroxaban (HR 0.80; 95% CrI 0.63-0.99; SUCRA 0.68), edoxaban (HR 0.96; 95% CrI 0.48-1.91; SUCRA 0.38) and dabigatran (HR 0.92; 95% CrI 0.68-1.28; SUCRA 0.37). In reducing the risk of MB, compared with VKAs, edoxaban had a SUCRA of 0.86 (HR 0.66; 95% CrI 0.50-0.92) followed by apixaban (HR 0.67; 95% CrI 0.55-0.87; SUCRA 0.83), and dabigatran (HR 0.79; 95% CrI 0.64-1.00; SUCRA 0.54). CONCLUSIONS: DOACs appear to have different efficacy and safety profiles and overall are preferable over VKAs in patients with AF with a history or risk of falls. Because of bias, further research is warranted. TRIAL REGISTRATION: PROSPERO identifier no. CRD42020201086.
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Galvain et al. (2026) conducted a meta-analysis in Atrial fibrillation. DOACs vs. Vitamin K antagonists (VKAs) was evaluated on Stroke/systemic embolism (SSE) and major bleeding (MB) (HR 0.72, 95% CI 0.59-0.96). Apixaban reduced stroke/systemic embolism (HR 0.72; 95% CrI 0.59-0.96) and edoxaban reduced major bleeding (HR 0.66; 95% CrI 0.50-0.92) compared with VKAs in AF patients at risk of falls.
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