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Meta-Analysis
. 2019 May 15;19(1):113.
doi: 10.1186/s12872-019-1089-0.

Comparing clinical outcomes of NOACs with warfarin on atrial fibrillation with Valvular heart diseases: a meta-analysis

Qiyu He  1 , Chun-Yat Sze  1 , Tin-Yau Shum  1 , Guang Hao  2 , Nga-Yin Belinda Wong  1 , Tat-Hang Sin  1 , Wei Wei  3 , Sujian Xia  4
Affiliations
Meta-Analysis

Comparing clinical outcomes of NOACs with warfarin on atrial fibrillation with Valvular heart diseases: a meta-analysis

Qiyu He et al. BMC Cardiovasc Disord. .

Abstract

Background: Warfarin is the standard of care and NOAC (Novel oral anticoagulants) are a group of newer drugs for such purposes. NOAC has a generally better profile (Clear interaction, less side effect, require less monitoring). However, its efficacy on valvular atrial fibrillation remains unclear.

Method: We researched literature articles from Embase, Cochrane and PubMed. Then we meta-analysed these six articles to assess pooled estimate of relative risk (RR) and 95% confidence intervals (Cl) using random-effects model for stroke, systemic embolic event, major bleeding and all-cause mortality. Heterogeneity across study was tested with Cochran's Q Test and I2 Test. The bias of studies was first tested by examining the symmetry of Funnel Plot. Cochrane's Collaboration Tool was also used to report any presented bias.

Results: We collected 496 articles in total and finally we included six articles in our meta-analysis. For SSEE (Stroke, Systemic Embolic Event), the pooled relative risk showed a significantly better clinical outcome of NOAC (RR: 0.66; 95% CI: 0.46 to 0.95). However, there is no significant difference in major bleeding (RR: 0.714, 95% CI:0.46 to 1.11) and all-cause mortality (RR: 0.84, 95% CI: 0.58 to 1.21).

Conclusion: Compared to Warfarin, NOAC is significantly more protective against the embolic event, but no significant difference in lowering risk of major bleeding, all-cause mortality or all aspects of post-TAVI (Trans-catheter aortic valve implantation).

Keywords: Atrial fibrillation; Meta-analysis; NOAC; Valvular heart disease; Warfarin.

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Conflict of interest statement

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Graphical illustration of the selection process
Fig. 2
Fig. 2
Funnel Plot for each individual outcome. 2a--SSEE; 2b--Major Bleeding; 2c--Mortality
Fig. 3
Fig. 3
Graphical illustration of Jackknife Sensitivity test for each individual outcome. 3a--SSEE; 3b--Major Bleeding; 3c--Mortality
Fig. 4
Fig. 4
Forest Plot for each individual outcome. There are 4a, 4b and 4c multi-panel figures included
See this image and copyright information in PMC

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