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Age Ageing. 2018 Jan 1;47(1):9-17. doi: 10.1093/ageing/afx103.

Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation: a systematic review and meta-regression analysis.

Author information

1
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B18 7QH, UK.
2
Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
3
Emergency Department of China-Japan Friendship Hospital, No. 2 Yinghua Dongjie, Hepingli, Chaoyang District, Beijing100029, China.
4
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
5
Service de Cardiologie, Pole Coeur Thorax Vasculaire, Centre Hospitalier, Universitaire Trousseau et Faculté de Médecine, Université Franis Rabelais, Tours, France.
6
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Shi, China.
7
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

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.

KEYWORDS:

atrial fibrillation; non-vitamin K anticoagulant agents, older people, systematic review; warfarin non-use; warfarin use

PMID:
28985259
DOI:
10.1093/ageing/afx103
[Indexed for MEDLINE]

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