Key result
NOACs cut gastrointestinal bleeding ~37% vs. VKAs in Asian patients with AF.
Why the study?
The gastrointestinal bleeding risk associated with NOACs compared with VKAs in Asian AF patients remained unaddressed.
Do NOACs reduce the risk of gastrointestinal bleeding compared with VKAs in Asian patients with atrial fibrillation?
Meta-Analysis (n=200,000)
Do NOACs reduce the risk of gastrointestinal bleeding compared with VKAs in Asian patients with atrial fibrillation?
Hazard Ratio: 0.633 (95% CI 0.535–0.748)
p-value: p=<0.001
In Asian patients with atrial fibrillation, NOACs present a safer gastrointestinal bleeding profile than traditional VKAs.
Supports NOAC preference over VKAs to lower GIB in Asian AF patients; extends mixed RCT-observational data but needs dedicated trials.
Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are more commonly used to prevent atrial fibrillation (AF) patients from thromboembolic events than vitamin K antagonists (VKAs). However, the gastrointestinal bleeding (GIB) risk in the Asian AF patients associated with NOACs in comparison with VKAs remained unaddressed. Materials and Methods: A systematic search of studies on NOACs and VKAs in the Asian AF patients was conducted in PubMed, Cochrane Library, and ClinicalTrials.gov. The primary outcome was the hazard ratio (HR) of any GIB associated with NOACs versus VKAs. The secondary outcome was the GIB risks in different kinds of NOACs compared with VKAs. Results: This meta-analysis included two randomized controlled trials (RCTs) and four retrospective studies, comprising at least 200,000 patients in total. A significantly lower HR of GIB risks was found in all kinds of NOACs than VKAs in the Asian AF patients (HR: 0.633; 95% confidence interval: 0.535–0.748; p < 0.001). Additionally, the GIB risks of different NOACs were apixaban (HR: 0.392), edoxaban (HR: 0.603), dabigatran (HR: 0.685), and rivaroxaban (HR: 0.794), respectively. Conclusions: NOACs significantly reduced the risk of GIB in the Asian AF patients compared with VKAs. In the four NOACs compared with VKAs, apixaban probably had a trend of the least GIB risk. We need further head-to-head studies of different NOACs to confirm which NOAC is the most suitable for Asian AF patients and to know the optimal dosage regimen of different NOACs.
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Yang et al. (2020) conducted a meta-analysis in Atrial Fibrillation (n=200,000). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Any gastrointestinal bleeding (GIB) (HR 0.633, 95% CI 0.535-0.748, p=<0.001). Non-vitamin K antagonist oral anticoagulants significantly reduced the risk of gastrointestinal bleeding compared with vitamin K antagonists in Asian patients with atrial fibrillation (HR 0.633).
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