Clinical Drug Investigation

, Volume 38, Issue 7, pp 579–591 | Cite as

Interventions and Strategies to Improve Oral Anticoagulant Use in Patients with Atrial Fibrillation: A Systematic Review of Systematic Reviews

  • Siok Shen Ng
  • Nai Ming Lai
  • Surakit Nathisuwan
  • Nathorn Chaiyakunapruk
Systematic Review



Anticoagulation therapy is the fundamental approach for stroke prevention in atrial fibrillation (AF) patients. Numerous systematic reviews comparing anticoagulation strategies have been published. We aim to summarize the efficacy and safety evidence of these strategies in AF patients from previously published systematic reviews.


We searched PubMed, EMBASE and Cochrane library from inception to Feb 24th, 2017, to identify systematic reviews and meta-analyses of randomized controlled trials that assessed interventions or strategies to improve oral anticoagulant use in AF patients.


Thirty-four systematic reviews were eligible for inclusion but only 11 were included in the qualitative analyses, corresponding to 40 unique meta-analyses, as the remaining systematic reviews had overlapping primary studies. There was insufficient evidence to support the efficacy of genotype-guided dosing and pharmacist-managed anticoagulation clinics for stroke prevention in AF patients. Conversely, patient’s self-management and novel oral anticoagulants (NOACs), in general were superior to warfarin for preventing stroke and reducing mortality. All interventions showed comparable risk of major bleeding with warfarin.


Findings from this overview support the superiority of NOACs and patient’s self-management for preventing stroke in AF patients. However, uncertainties remain on the benefits of genotype-guided dosing and pharmacist-managed anticoagulation clinics due to poor quality evidence, and future research is warranted.



We are grateful for the help of Dr. Shaun Lee Wen Huey from School of Pharmacy, Monash University Malaysia for his invaluable advice and support in the preparation of this manuscript.

Compliance with Ethical Standards


This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

Siok Shen Ng, Nai Ming Lai, Surakit Nathisuwan and Nathorn Chaiyakunapruk have no conflict of interest to declare.

Author Contributions

All authors have made substantial contributions to the research design, or the acquisition, analysis, or interpretation of data; and to drafting the paper or revising it critically; and that all authors have approved the submitted version.

Supplementary material

40261_2018_641_MOESM1_ESM.pdf (956 kb)
Supplementary material 1 (PDF 957 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of PharmacyMonash University MalaysiaBandar SunwayMalaysia
  2. 2.Department of PharmacyHospital MelakaMelakaMalaysia
  3. 3.School of MedicineTaylor’s University MalaysiaSubang JayaMalaysia
  4. 4.Clinical Pharmacy Division, Department of Pharmacy, Faculty of PharmacyMahidol UniversityBangkokThailand
  5. 5.Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research (CPOR)Naresuan UniversityPhitsanulokThailand
  6. 6.School of PharmacyUniversity of WisconsinMadisonUSA
  7. 7.Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University MalaysiaBandar SunwayMalaysia

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