June 29, 2020MedicineOpen Access

The role of non-vitamin K antagonist oral anticoagulants in Asian patients with atrial fibrillation

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Why the study?

Given the substantial burden of AF and AF-related stroke in Asia, stroke prevention is an urgent issue, prompting an assessment of the role of NOACs in Asian patients with AF.

Do NOACs reduce the risk of stroke or systemic embolism and major bleeding compared to warfarin in Asian patients with atrial fibrillation?

Structured PICO

Do NOACs reduce the risk of stroke or systemic embolism and major bleeding compared to warfarin in Asian patients with atrial fibrillation?

Population

Asian patients with atrial fibrillation (17 studies included)

Intervention

Non-vitamin K antagonist oral anticoagulants (NOACs: dabigatran, rivaroxaban, apixaban, edoxaban)

Comparator

Warfarin

Outcome

Stroke or systemic embolismcomposite

In Asian patients with atrial fibrillation, NOACs are at least as effective and safer than warfarin, with apixaban showing the best efficacy and edoxaban the best safety profile.

Implication

Supports preferring NOACs over warfarin in Asian AF; confirms safety benefits and extends rankings of individual agents.

Abstract

BACKGROUND: Given the huge burden of atrial fibrillation (AF) and AF-related stroke in Asia, stroke prevention represents an urgent issue in this region. We herein performed a network meta-analysis to examine the role of non-vitamin K antagonist oral anticoagulants (NOACs) in Asian patients with AF. METHODS: A systematic search of the publications was conducted in PubMed and Embase databases for eligible studies until July 2019. The odds ratios (ORs) and 95% confidence intervals (CIs) were regarded as the effect estimates. The surface under the cumulative ranking area (SUCRA) for the ranking probabilities was calculated. RESULTS: A total of 17 studies were included. For comparisons of NOACs vs warfarin, dabigatran (OR = 0.77, 95% CI 0.68-0.86), rivaroxaban (OR = 0.72, 95% CI 0.65-0.81), apixaban (OR = 0.56, 95% CI 0.49-0.65), but not edoxaban reduced the risk of stroke or systemic embolism, wheres dabigatran (OR = 0.56, 95% CI 0.41-0.76), rivaroxaban (OR = 0.66, 95% CI 0.50-0.86), apixaban (OR = 0.49, 95% CI 0.36-0.66), and edoxaban (OR = 0.34, 95% CI 0.24-0.49) decreased the risk of major bleeding. In reducing the risk of stroke or systemic embolism, apixaban and rivaroxaban ranked the best and second best (SUCRA 0.2% and 31.4%, respectively), followed by dabigatran (50.2%), edoxaban (75.2%), and warfarin (93.0%). In reducing the risk of major bleeding, edoxaban, and apixaban ranked the best and second best (1.5% and 30.8%, respectively), followed by dabigatran (48.4%), rivaroxaban (69.2%), and warfarin (100%). CONCLUSION: NOACs were at least as effective as warfarin, but more safer in Asians with AF. Apixaban was superior to other NOACs for reducing stroke or systemic embolism, while edoxaban showed a better safety profile than other NOACs.