Key result
Non-vitamin K oral antagonists showed similar efficacy to vitamin K antagonists for preventing ischemic stroke in atrial fibrillation patients with and without valvular heart disease (RR 0.97), while significantly reducing the risk of intracranial bleeding.
Why the study?
AF poses a significant stroke risk in heart disease patients, motivating an evaluation of NOACs versus VKAs in AF patients with and without valvular heart disease.
Do non-vitamin K oral antagonists (NOACs) reduce ischemic stroke and bleeding compared to vitamin K antagonists in patients with atrial fibrillation with and without valvular heart disease?
Meta-Analysis (n=85,423)
Yes
Do non-vitamin K oral antagonists (NOACs) reduce ischemic stroke and bleeding compared to vitamin K antagonists in patients with atrial fibrillation with and without valvular heart disease?
Relative Risk: 0.97 (95% CI 0.72–1.3)
p-value: p=0.83
NOACs are as effective as VKAs for stroke prevention in AF patients with and without valvular heart disease, while offering a superior safety profile with significantly lower risks of intracranial and gastrointestinal bleeding.
Supports NOAC alternatives to VKAs across AF with/without VHD; extends prior non-valvular evidence to mixed valvular cohorts.
BACKGROUND: Atrial fibrillation (AF) poses a significant stroke risk in heart disease patients. This systematic review aims to evaluate the efficacy and safety of non-vitamin K oral antagonists (NOACs) versus vitamin K antagonists (VKAs) in AF patients with and without any valvular heart disease (VHD/N-VHD). METHODS: A systematic search was conducted on PubMed, Scopus, and Google Scholar up to March 3, 2022. Efficacy and safety parameters were analyzed. RESULTS: A total of 85,423 subjects from 10 studies were included in this meta-analysis. NOACs and VKAs showed similar effects on ischemic stroke in AF patients with VHD/N-VHD (RR 0.97; 95% CI 0.72-1.30; p = 0.83) and also on systemic embolic events (RR 1.02; 95% CI 0.83-1.25; p = 0.86). Similar effects were seen in VHD and N-VHD subgroups. Both treatments had similar effects on myocardial infarction in AF patients with VHD/N-VHD (RR 0.79; 95% CI 0.49-1.26; p = 0.32), VHD (RR 0.78; 95% CI 0.59-1.02; p = 0.07), and N-VHD subgroups (RR 0.82; 95% CI 0.30-2.21; p = 0.69). NOACs reduced the risk of intracranial bleeding in AF VHD/N-VHD (RR 0.64; 95% CI 0.54-0.77; p < 0.0001), VHD (RR 0.59; 95% CI 0.42-0.82; p = 0.002), and N-VHD subgroups (RR 0.70; 95% CI 0.57-0.85; p = 0.0003). Additionally, NOACs reduced the risk of gastrointestinal bleeding in AF VHD/N-VHD (RR 0.80; 95% CI 0.66-0.96; p = 0.02), specifically in the VHD subgroup (RR 0.69; 95% CI 0.54-0.89; p = 0.004). Moreover, NOACs were associated with a decreased risk for minor and non-fatal bleeding in AF patients with VHD/N-VHD (RR 0.86; 95% CI 0.75-0.99; p = 0.04). CONCLUSION: NOACs are effective and safe for ischemic stroke, systemic embolic events, myocardial infarction, intracranial bleeding, and gastrointestinal bleeding in AF patients with VHD/N-VHD.
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Adji et al. (2024) conducted a meta-analysis in Atrial fibrillation with and without valvular heart disease (n=85,423). Non-vitamin K oral antagonists (NOACs) vs. Vitamin K antagonists (VKAs) / Warfarin was evaluated on Ischemic stroke (RR 0.97, 95% CI 0.72-1.30, p=0.83). Non-vitamin K oral antagonists showed similar efficacy to vitamin K antagonists for preventing ischemic stroke in atrial fibrillation patients with and without valvular heart disease (RR 0.97), while significantly reducing the risk of intracranial bleeding.
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