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Non-vitamin K antagonist oral anticoagulants in Asian patients with atrial fibrillation: evidences from the real-world data

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Abstract

The role of non-vitamin K antagonist oral anticoagulants (NOACs) in stroke prevention remains unclear in Asian patients with atrial fibrillation (AF). Therefore, we performed a meta-analysis to compare the efficacy and safety outcomes of NOACs in Asian patients with AF from the real-world settings. The PubMed and Embase databases were systematically searched to identify eligible observational studies until June 2019. The odds ratios (OR) and 95% confidence intervals (CIs) were calculated and then pooled by a random-effects model. A total of 18 observational studies were included. Compared with warfarin, dabigatran (OR, 0.56, 95% CI 0.43–0.73), rivaroxaban (OR, 0.54, 95% CI 0.44–0.67), apixaban (OR, 0.41, 95% CI 0.35–0.48), and edoxaban (OR, 0.19, 95% CI 0.14– 0.25) reduced the risk of major bleeding, while dabigatran (OR, 0.78, 95% CI 0.71–0.85), rivaroxaban (OR, 0.74, 95% CI 0.68–0.82), and edoxaban (OR, 0.29, 95% CI 0.22–0.39) were associated with reduced risks of stroke or systemic embolism. In addition, dabigatran versus apixaban was associated with increased risks of ischemic stroke and gastrointestinal bleeding, while rivaroxaban versus apixaban was associated with elevated risks of stroke or systemic embolism, ischemic stroke, intracranial hemorrhage, and gastrointestinal bleeding. In Asian patients with AF, NOACs are non-inferior to warfarin for stroke prevention, and apixaban may be a better choice compared with dabigatran or rivaroxaban.

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Authors and Affiliations

  1. Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, Jiangxi, China

    Zhengbiao Xue, Chaoyu Wu, Jie Lin & Xin Liu

  2. Department of Children’s Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China

    Yue Zhou

  3. Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China

    Wengen Zhu

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Contributions

ZB-X, Y-Z, and WG-Z performed the literature search, study selection and data extraction, quality assessment, and statistical analysis. CY-W, J-L, and X-L help check the data to ensure accuracy. ZB-X and Y-Z wrote the original draft, while WG-Z revised the draft. WG-Z edited the manuscript prior to submission to ensure the standard English grammar.

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Correspondence to Wengen Zhu.

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Zhengbiao Xue and Yue Zhou are co-first authors

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Xue, Z., Zhou, Y., Wu, C. et al. Non-vitamin K antagonist oral anticoagulants in Asian patients with atrial fibrillation: evidences from the real-world data. Heart Fail Rev 25, 957–964 (2020). https://doi.org/10.1007/s10741-019-09878-y

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