Angelo Silverio1, Marco Di Maio2, Costantina Prota1, Elena De Angelis1, Ilaria Radano1, Rodolfo Citro1, Albino Carrizzo3, Michele Ciccarelli1, Carmine Vecchione1,3, Davide Capodanno4, Gennaro Galasso1. 1. Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città di Ippocrate, Salerno 84131, Italy. 2. Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, A.O.R.N. "Ospedali dei Colli", Naples 80131, Italy. 3. Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia 86077, Italy. 4. Division of Cardiology, AOU Policlinico-Vittorio Emanuele, Catania 95100, Italy.
Abstract
AIMS: The aim of the present meta-analysis was to evaluate the efficacy and safety of non-vitamin K oral antagonists (NOACs) vs. vitamin K antagonists (VKAs) in elderly patients with atrial fibrillation (AF) and indirectly compare NOACs in this population. METHODS AND RESULTS: MEDLINE, Cochrane, ISI Web of Sciences, and SCOPUS were searched for randomized or adjusted observational studies comparing NOACs vs. VKAs for stroke prevention in AF patients ≥75 years. The primary efficacy and safety outcomes of this meta-analysis were the composite of stroke and systemic embolism (SSE) and major bleedings, respectively. Other secondary outcomes were also analysed. The analysis included 22 studies enrolling 440 281 AF patients ≥ 75 years. The risk of SSE was significantly lower with NOACs vs. VKAs [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.70-0.89], whereas no differences were found for major bleedings (HR 0.94; 95% CI 0.85-1.05). NOACs reduced the risk of intracranial bleeding (HR 0.46; 95% CI 0.38-0.58), haemorrhagic stroke (HR 0.61; 95% CI 0.48-0.79) and fatal bleeding (HR 0.46; 95% CI 0.30-0.72) but increased gastrointestinal (GI) bleedings (HR 1.46; 95% CI 1.30-1.65), compared to VKAs. The adjusted indirect comparison showed no significant differences in term of SSE between NOAC agents. Conversely, the risk of major bleeding was higher for rivaroxaban vs. apixaban (HR 1.69; 95% CI 1.39-2.08) and edoxaban (HR 1.37; 95% CI 1.14-1.67), and for dabigatran vs. apixaban (HR 1.47; 95% CI 1.18-1.85). CONCLUSION: In elderly patients with AF, NOACs are associated to a lower risk of SSE, intracranial bleeding, haemorrhagic stroke and fatal bleeding than VKAs, but increase GI bleedings. In this analysis, the safety profile of individual NOAC agents was significantly different. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The aim of the present meta-analysis was to evaluate the efficacy and safety of non-vitamin K oral antagonists (NOACs) vs. vitamin K antagonists (VKAs) in elderly patients with atrial fibrillation (AF) and indirectly compare NOACs in this population. METHODS AND RESULTS: MEDLINE, Cochrane, ISI Web of Sciences, and SCOPUS were searched for randomized or adjusted observational studies comparing NOACs vs. VKAs for stroke prevention in AF patients ≥75 years. The primary efficacy and safety outcomes of this meta-analysis were the composite of stroke and systemic embolism (SSE) and major bleedings, respectively. Other secondary outcomes were also analysed. The analysis included 22 studies enrolling 440 281 AF patients ≥ 75 years. The risk of SSE was significantly lower with NOACs vs. VKAs [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.70-0.89], whereas no differences were found for major bleedings (HR 0.94; 95% CI 0.85-1.05). NOACs reduced the risk of intracranial bleeding (HR 0.46; 95% CI 0.38-0.58), haemorrhagic stroke (HR 0.61; 95% CI 0.48-0.79) and fatal bleeding (HR 0.46; 95% CI 0.30-0.72) but increased gastrointestinal (GI) bleedings (HR 1.46; 95% CI 1.30-1.65), compared to VKAs. The adjusted indirect comparison showed no significant differences in term of SSE between NOAC agents. Conversely, the risk of major bleeding was higher for rivaroxaban vs. apixaban (HR 1.69; 95% CI 1.39-2.08) and edoxaban (HR 1.37; 95% CI 1.14-1.67), and for dabigatran vs. apixaban (HR 1.47; 95% CI 1.18-1.85). CONCLUSION: In elderly patients with AF, NOACs are associated to a lower risk of SSE, intracranial bleeding, haemorrhagic stroke and fatal bleeding than VKAs, but increase GI bleedings. In this analysis, the safety profile of individual NOAC agents was significantly different. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Agnieszka Kapłon-Cieślicka; Monika Gawałko; Monika Budnik; Beata Uziębło-Życzkowska; Paweł Krzesiński; Katarzyna Starzyk; Iwona Gorczyca-Głowacka; Ludmiła Daniłowicz-Szymanowicz; Damian Kaufmann; Maciej Wójcik; Robert Błaszczyk; Jarosław Hiczkiewicz; Katarzyna Łojewska; Katarzyna Mizia-Stec; Maciej T Wybraniec; Katarzyna Kosmalska; Marcin Fijałkowski; Anna Szymańska; Mirosław Dłużniewski; Maciej Haberka; Michał Kucio; Błażej Michalski; Karolina Kupczyńska; Anna Tomaszuk-Kazberuk; Katarzyna Wilk-Śledziewska; Renata Wachnicka-Truty; Marek Koziński; Paweł Burchardt; Piotr Scisło; Radosław Piątkowski; Janusz Kochanowski; Grzegorz Opolski; Marcin Grabowski Journal: J Clin Med Date: 2022-05-11 Impact factor: 4.964
Authors: Joris J Komen; Eibert R Heerdink; Olaf H Klungel; Aukje K Mantel-Teeuwisse; Tomas Forslund; Björn Wettermark; Paul Hjemdahl Journal: Eur Heart J Cardiovasc Pharmacother Date: 2021-04-09
Authors: Davide Capodanno; Marco Di Maio; Antonio Greco; Deepak L Bhatt; C Michael Gibson; Andreas Goette; Renato D Lopes; Roxana Mehran; Pascal Vranckx; Dominick J Angiolillo Journal: J Am Heart Assoc Date: 2020-08-01 Impact factor: 5.501