Key result
In frail patients with atrial fibrillation, NOACs were associated with a lower risk of ischemic stroke compared to warfarin.
Why the study?
Frail patients with AF are at higher risk for cerebral infarction and death, but limited data exist regarding the best anticoagulation strategy in this population.
Do NOACs reduce ischemic strokes, systemic embolism, and bleeding compared to warfarin in frail elderly patients with atrial fibrillation?
Meta-Analysis (n=188,573)
Do NOACs reduce ischemic strokes, systemic embolism, and bleeding compared to warfarin in frail elderly patients with atrial fibrillation?
In frail elderly patients with atrial fibrillation, NOACs demonstrate superior efficacy and safety compared to warfarin, significantly reducing ischemic stroke, major bleeding, and cardiovascular death.
Answers are grounded in this paper and cite their sources.
Optimal anticoagulation in frail AF patients remains unclear; leaves open need for randomized trials.
Background Frail patients with atrial fibrillation (AF) are thought to be at a higher risk for cerebral infarction and death than patients who are not frail, making preventive interventions important. Anticoagulants should be used in frailty patients with AF. However, there are limited data about anticoagulants in frail patients with AF. Therefore, we concucted this meta-analysis to find the best anticoagulation strategy.Methods Systematic electronic searches were conducted on 4 July 2022 4 July 2022, in PubMed, Embase (Ovid), and Cochrane Library. Relevant and eligible cohort studies were included. A random-effects model was used to estimate the pooled Hazard ratio (HR) and 95% confidence intervals (CI). Furthermore, we performed a publication bias analysis and subgroup analysis to explore the source of heterogeneity.Result 3 publications (10 cohorts, 188573 participants) met our inclusion criteria. The pooled analysis showed that ischemic strokes (HR: 0.75; 95%CI: 0.71 to 0.79; I2 = 60.2%), systemic embolism (HR: 0.75; 95%CI: 0.64 to 0.87; I = 68.6%), major bleeding(HR: 0.76; 95%CI: 0.64 to 0.89; I2 = 97.4%), intracranial hemorrhage (HR: 0.57; 95%CI: 0.45 to 0.71; I2 = 54.6%) and cardiovascular death(HR: 0.61; 95%CI: 0.51 to 0.70; I2 = 83.2%) were lower in NOACs as compared with warfarin. Regarding gastrointestinal bleeding, meta-analysis showed no significant differences in the risk of gastrointestinal bleeding (HR: 0.97; 95%CI: 0.69 to 1.36; I2 = 95.9%). Conclusion NOAC was more effective and safety than warfarin in frail patients with AF.
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Hu et al. (2023) conducted a meta-analysis in Frail patients with atrial fibrillation (n=188,573). NOACs vs. Warfarin was evaluated on Ischemic strokes (HR 0.75, 95% CI 0.71 to 0.79). In frail patients with atrial fibrillation, NOACs were associated with a lower risk of ischemic stroke compared to warfarin.
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