In older patients with atrial fibrillation, NOACs were superior to warfarin for stroke or thromboembolism prevention (HR 0.81; 95% CI 0.73-0.89) and reduced the risk of major bleeding.
Meta-Analysis
Do oral anticoagulants (warfarin or NOACs) reduce stroke/thromboembolism in older patients (≥65 years) with atrial fibrillation?
In older patients with atrial fibrillation, NOACs are superior to warfarin for both stroke prevention and major bleeding reduction, while warfarin is superior to aspirin or no therapy.
Hazard Ratio: 0.81 (95% CI 0.73–0.89)
Background and objective: the study analysed the effectiveness and safety of warfarin use compared with warfarin non-use and non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients aged ≥65 years. Methods: after searching PubMed and the Cochrane Library, 26 studies were included, with 10 comparing warfarin with warfarin non-use and 16 comparing warfarin with NOACs, in older AF patients (≥65 years). Results: warfarin use was superior to no antithrombotic therapy relative risk (RR) 0.59, 95% confidence interval (CI) 0.51-0.76, I2 = 12.3%, n = 8 and aspirin (RR 0.44, 95% CI 0.24-0.64, I2 = 0.0%, n = 5) for stroke/thromboembolism (TE) prevention. Warfarin use was associated with a non-significant increase in risk of major bleeding compared with no antithrombotic therapy (RR 1.26, 95% CI 0.99-1.52, I2 = 0.0%, n = 7) and aspirin (RR 1.20, 95% CI 0.91-1.50, I2 = 0.0%, n = 5). NOACs were superior to warfarin for stroke/TE prevention hazard ratio (HR) 0.81, 95% CI 0.73-0.89, I2 = 56.6%, n = 9, and also were associated with reduced risk of major bleeding compared to warfarin (HR 0.87, 0.77-0.97, I2 = 86.1%, n = 9). Conclusions: warfarin use was superior to warfarin non-use, aspirin and no antithrombotic therapy in reducing the risk of stroke/TE in older AF patients, but with a possible increase in major bleeding. NOACs were superior to warfarin for stroke/TE prevention, with reduced risk of major bleeding.
Bai et al. (2017) conducted a meta-analysis in atrial fibrillation. NOACs vs. Warfarin was evaluated on stroke/thromboembolism (TE) (HR 0.81, 95% CI 0.73-0.89). In older patients with atrial fibrillation, NOACs were superior to warfarin for stroke or thromboembolism prevention (HR 0.81; 95% CI 0.73-0.89) and reduced the risk of major bleeding.