Meta-Analysis of Direct-Acting Oral Anticoagulants Compared With Warfarin in Patients >75 Years of Age
Section snippets
Methods
A literature search was performed in PubMed, Embase, and Cochrane Central through December 12, 2018. The keywords utilized were “nonvitamin K antagonist oral anticoagulants” or “direct oral anticoagulants” or “dabigatran” or “rivaroxaban” or “apixaban” or “edoxaban” AND “stroke” or “systemic embolism” or “major bleeding” or “intracranial hemorrhage,” with the limits for humans and RCTs activated. No restriction for language or publication year was used. The studies were electronically and
Results
Our initial search yielded 1,409 articles. After electronic deduplication, 1,113 studies remained. A further title and the abstract review led to the exclusion of the least relevant articles, and 13 articles were selected for the final full-text review (Figure 1). On full-text review, 5 RCTs, including 27,639 older patients with nonvalvular AF randomized to a DOAC or warfarin, were selected for meta-analysis.9, 10, 11, 12, 13 Table 1 shows the baseline characteristics in the trials.
Figure 2
Discussion
In this comprehensive meta-analysis of data from RCTs evaluating the safety and efficacy of DOACs compared with warfarin, we report novel and important findings in the subgroup of older AF patients. First, DOACs as a class were superior to warfarin with respect to both efficacy and safety; second, individual DOACs demonstrated similar efficacy to each other in the prevention of SSE; third, apixaban was associated with the lowest risk of major bleeding; fourth, apixaban, edoxaban, and dabigatran
Disclosures
None of the authors have any conflicts of interest or funding sources to disclose.
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Funding: None.