Key result
Oral anticoagulant therapy reduced the risk of stroke or systemic embolism (HR 0.71) and all-cause death (HR 0.66) compared to no anticoagulant therapy in patients with atrial fibrillation and prior gastrointestinal bleeding.
Why the study?
AF patients with prior gastrointestinal bleeding were excluded from most randomized controlled trials on anticoagulation therapy, leaving the effect of oral anticoagulant therapy in this population unclear.
Does the resumption of oral anticoagulant therapy reduce stroke, systemic embolism, and all-cause death in patients with atrial fibrillation and prior gastrointestinal bleeding?
Meta-Analysis (n=57,623)
Does the resumption of oral anticoagulant therapy reduce stroke, systemic embolism, and all-cause death in patients with atrial fibrillation and prior gastrointestinal bleeding?
Effect estimate: HR 0.71 (95% CI 0.59-0.84)
In AF patients with prior gastrointestinal bleeding, resuming OAC therapy (especially NOACs) significantly reduces the risk of stroke, systemic embolism, and all-cause death without significantly increasing recurrent GIB compared to no anticoagulation.
Background Gastrointestinal bleeding (GIB) commonly complicates anticoagulant therapy for patients with atrial fibrillation (AF). However, AF patients with prior GIB were excluded from most randomized controlled trials on anticoagulation therapy. Therefore, we conducted a systematic review and meta-analysis to assess the effect of oral anticoagulant (OAC) therapy in this specific population. Methods Randomized trials and observational studies reporting the data about the resumption of OAC therapy among AF patients with prior GIB were included. The search was performed in the PubMed and Embase databasesup to March 2022. The adjusted hazard ratios ( HR s) and 95% confidence intervals ( CI s) were pooled by a random-effects model with an inverse variance method. Results A total of 7 studies involving 57,623 patients were included. Compared with no anticoagulant therapy, OAC therapy was associated with decreased risks of stroke or systemic embolism ( HR = 0.71, 95% CI : 0.59–0.84) and all-cause death ( HR = 0.66, 95% CI : 0.60–0.72), but there was no significant difference in the risk of recurrent GIB ( HR = 1.22, 95% CI : 0.94–1.59). Compared with vitamin K antagonists, non-vitamin K antagonist oral anticoagulants (NOACs) were associated with reduced risks of stroke or systemic embolism ( HR = 0.61, 95% CI : 0.54–0.68), all-cause mortality ( HR = 0.86, 95% CI : 0.75–0.99), major bleeding ( HR = 0.75, 95% CI : 0.66–0.84), and GIB recurrence ( HR = 0.83, 95% CI : 0.72–0.96). Conclusions In AF patients with prior GIB, OAC therapy (especially NOACs) demonstrated superior effectiveness compared with no anticoagulant therapy.
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Zhao et al. (2022) conducted a meta-analysis in Atrial fibrillation with prior gastrointestinal bleeding (n=57,623). Oral anticoagulants (OAC) vs. No anticoagulant therapy was evaluated on Stroke or systemic embolism (SSE) (HR 0.71, 95% CI 0.59-0.84). Oral anticoagulant therapy reduced the risk of stroke or systemic embolism (HR 0.71) and all-cause death (HR 0.66) compared to no anticoagulant therapy in patients with atrial fibrillation and prior gastrointestinal bleeding.
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