Key result
Compared with warfarin, edoxaban reduced the incidence of cardiovascular death by 14% as well as major and non-major bleeding in patients with atrial fibrillation.
Why the study?
Warfarin reduces stroke incidence and mortality while edoxaban reduces bleeding risk in AF, motivating an evaluation of the efficacy and safety of edoxaban versus warfarin in preventing clinical events.
Does edoxaban reduce clinical events and bleeding compared to warfarin in patients with atrial fibrillation?
Meta-Analysis (n=24,836)
Double-blind
Randomized
Yes
Does edoxaban reduce clinical events and bleeding compared to warfarin in patients with atrial fibrillation?
In patients with atrial fibrillation, edoxaban significantly reduces cardiovascular death and bleeding events compared to warfarin, without increasing the risk of stroke, systemic embolism, or myocardial infarction.
Answers are grounded in this paper and cite their sources.
Supports preferring edoxaban over warfarin in atrial fibrillation to reduce cardiovascular death and bleeding; confirms meta-analytic superiority versus vitamin K antagonists.
Atrial fibrillation (AF) is the most common type of arrhythmia. Warfarin reduces the incidence and mortality of strokes in patients with AF. Edoxaban reduces the bleeding risk in patients with AF. This study evaluates the efficacy and safety of edoxaban versus warfarin in preventing clinical events in patients with AF through a meta-analysis of randomized controlled trials (RCTs). RCTs were retrieved from medical literature databases. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the primary and safety endpoints. In total, five articles (10 trial comparisons) containing 24,836 patients were retrieved. Of these patients, 16,268 (65.5%) received edoxaban and 8,568 (34.5%) received warfarin. Compared with warfarin, edoxaban significantly reduced the incidence of cardiovascular death (CVD), major bleeding, and non-major bleeding (RR: 0.86, 95% CI: 0.80-0.93, I2 : 0.0%; RR: 0.65, 95% CI: 0.59-0.71, I2 : 75.6%; and RR: 0.80, 95% CI: 0.77-0.84, I2 : 79.3%, respectively). Edoxaban did not increase the incidence of stroke, systemic embolic events, myocardial infarction, and adverse events compared with warfarin (RR: 1.00, 95% CI: 0.90-1.11, I2 : 42.8%; RR: 1.00, 95% CI: 0.67-1.49, I2 : 0.0%; RR: 1.08, 95% CI: 0.93-1.27, I2 : 0.0%; RR: 1.00, 95% CI: 0.91-1.10, I2: 46.4%, respectively). This meta-analysis indicated that compared with warfarin, edoxaban can significantly reduce the incidence of CVD and major and non-major bleeding. The anticoagulant effect and safety of edoxaban may be better than those of warfarin.
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A 2020 study conducted a meta-analysis in Atrial fibrillation (n=24,836). Edoxaban vs. Warfarin was evaluated on Cardiovascular death (CVD) (RR 0.86, 95% CI 0.80-0.93). Compared with warfarin, edoxaban reduced the incidence of cardiovascular death by 14% as well as major and non-major bleeding in patients with atrial fibrillation.
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