Key result
Compared with warfarin, NOACs significantly reduced the risk of stroke or systemic embolism (RR 0.82) and intracranial hemorrhage (RR 0.41) in patients with atrial fibrillation and coronary artery disease.
Why the study?
The efficacy and safety of NOACs in atrial fibrillation with coronary or peripheral artery disease remain largely unresolved.
Do NOACs reduce stroke, systemic embolism, and bleeding compared to warfarin in patients with atrial fibrillation and concomitant coronary or peripheral artery disease?
Meta-Analysis (n=21,831)
Do NOACs reduce stroke, systemic embolism, and bleeding compared to warfarin in patients with atrial fibrillation and concomitant coronary or peripheral artery disease?
Relative Risk: 0.82 (95% CI 0.7–0.96)
p-value: p=0.02
NOACs are at least as effective and safe as warfarin in AF patients with CAD or PAD, offering significant reductions in stroke and intracranial hemorrhage in those with CAD.
Supports preferring NOACs over warfarin in AF with CAD to reduce stroke and ICH; extends evidence to this high-risk subgroup.
The efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) with coronary or peripheral artery disease (CAD or PAD) remain largely unresolved. We, therefore, conducted a meta-analysis to explore the effect of NOACs compared with warfarin in these populations.We systematically searched the Cochrane Library, PubMed, and Embase databases for randomized controlled trials (RCTs) involving NOACs versus warfarin in AF patients with CAD or PAD. A random-effect model was selected to pool the risk ratios (RRs) and 95% confidence intervals (CIs).A total of 7 RCTs were included. In AF patients with CAD, compared with warfarin use, the use of NOACs was associated with reduced risks of stroke/systemic embolism (RR 0.82; 95% CI 0.70-0.96) and intracranial hemorrhage (RR 0.41; 95% CI 0.26-0.63), but NOACs versus warfarin showed similar risks of all-cause death (RR 0.95; 95% CI 0.86-1.05), cardiovascular death (RR 0.95; 95% CI 0.80-1.13), stroke (RR 0.80; 95% CI 0.64-1.00), myocardial infarction (RR 1.00; 95% CI 0.83-1.21), and major bleeding (RR 0.82; 95% CI 0.65-1.04). Among patients with AF and PAD, NOACs versus warfarin had similar risks for stroke (RR 0.93; 95% CI 0.61-1.42), myocardial infarction (RR 1.10; 95% CI 0.64-1.90), all-cause death (RR 0.91; 95% CI 0.70-1.19), major bleeding (RR 1.12; 95% CI 0.70-1.81), and intracranial hemorrhage (RR 0.54; 95% CI 0.16-1.85).NOACs seem to be at least as effective and safe as warfarin in AF patients with CAD. whereas NOACs versus warfarin have similar efficacy and safety in patients with PAD.
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Zhang et al. (2020) conducted a meta-analysis in Atrial fibrillation with coronary or peripheral artery disease (n=21,831). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Warfarin was evaluated on Stroke or systemic embolism in patients with coronary artery disease (RR 0.82, 95% CI 0.70-0.96, p=0.02). Compared with warfarin, NOACs significantly reduced the risk of stroke or systemic embolism (RR 0.82) and intracranial hemorrhage (RR 0.41) in patients with atrial fibrillation and coronary artery disease.
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