The Safety and Efficacy of Rivaroxaban Compared with Warfarin in Patients with Atrial Fibrillation and Diabetes: A Systematic Review and Meta-analysis
Aims This meta-analysis was conducted to compare the efficacy and safety of rivaroxaban with warfarin in patients with atrial fibrillation (AF) and diabetes mellitus. Methods PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched from the establishment of databas...
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| Veröffentlicht in: | American journal of cardiovascular drugs : drugs, devices, and other interventions devices, and other interventions, 2021, Vol.21 (1), p.51-61 |
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| creator | Hua, Yang Sun, Jin-Yu Su, Yue Qu, Qiang Wang, Hong-Ye Sun, Wei Kong, Xiang-Qing |
| description | Aims
This meta-analysis was conducted to compare the efficacy and safety of rivaroxaban with warfarin in patients with atrial fibrillation (AF) and diabetes mellitus.
Methods
PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched from the establishment of databases up to 15 October 2019. Studies on efficacy and safety outcomes of rivaroxaban and warfarin were included. Efficacy and safety outcomes, including stroke, ischemic stroke, stroke or systemic embolism, myocardial infarction, major adverse cardiac events, major bleeding, intracranial hemorrhage, and major gastrointestinal bleeding were collected for meta-analysis.
Results
Compared with warfarin, rivaroxaban could significantly reduce stroke (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.63–0.95;
P
= 0.01), ischemic stroke (RR 0.74; 95% CI 0.63–0.87;
P
= 0.0004), stroke or systemic embolism (RR 0.73; 95% CI 0.60–0.89;
P
= 0.002), myocardial infarction (RR 0.68; 95% CI 0.56–0.82;
P
|
| doi_str_mv | 10.1007/s40256-020-00407-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2564585418</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2564585418</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-cbfb69011629f4d5ae96f7ac2f8579460373406e1fc49816f50d892f7dc7d0f73</originalsourceid><addsrcrecordid>eNp9kd1u1DAQhS1ERUvhBbhAlrg2tR3_JNytlhaQWhX1R-XOmjg2dZVNtra3JX0QnrfupsAd0kge6XxzxpqD0DtGPzJK9UESlEtFKKeEUkE1eXiB9hjTDWG1_vFy20tSca130euUbihlmuvmFdqtuGSiVmoP_b64dvgcvMsThqHDh94HC3bCo8dn4Q7i-AtaGPByXK0hug7fh3yNryB6iGHApb5DDm7IaVYWOQbo8VFoY-j7Io3D1vdzgNZllz7hBT6fUnaroll85u6Cu98SJy4DgQH6KYX0Bu146JN7-_zuo8ujw4vlV3J8-uXbcnFMbKVlJrb1rWooY4o3XnQSXKO8Bst9LXUjFK10JahyzFvR1Ex5Sbu64V53VnfU62offZh913G83biUzc24ieUTyZTTCllLwepC8ZmycUwpOm_WMawgToZR8xSFmaMwJQqzjcI8lKH3z9abduW6vyN_bl-AagZSkYafLv7b_R_bR5wzlgA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2564585418</pqid></control><display><type>article</type><title>The Safety and Efficacy of Rivaroxaban Compared with Warfarin in Patients with Atrial Fibrillation and Diabetes: A Systematic Review and Meta-analysis</title><source>SpringerLink Journals - AutoHoldings</source><creator>Hua, Yang ; Sun, Jin-Yu ; Su, Yue ; Qu, Qiang ; Wang, Hong-Ye ; Sun, Wei ; Kong, Xiang-Qing</creator><creatorcontrib>Hua, Yang ; Sun, Jin-Yu ; Su, Yue ; Qu, Qiang ; Wang, Hong-Ye ; Sun, Wei ; Kong, Xiang-Qing</creatorcontrib><description>Aims
This meta-analysis was conducted to compare the efficacy and safety of rivaroxaban with warfarin in patients with atrial fibrillation (AF) and diabetes mellitus.
Methods
PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched from the establishment of databases up to 15 October 2019. Studies on efficacy and safety outcomes of rivaroxaban and warfarin were included. Efficacy and safety outcomes, including stroke, ischemic stroke, stroke or systemic embolism, myocardial infarction, major adverse cardiac events, major bleeding, intracranial hemorrhage, and major gastrointestinal bleeding were collected for meta-analysis.
Results
Compared with warfarin, rivaroxaban could significantly reduce stroke (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.63–0.95;
P
= 0.01), ischemic stroke (RR 0.74; 95% CI 0.63–0.87;
P
= 0.0004), stroke or systemic embolism (RR 0.73; 95% CI 0.60–0.89;
P
= 0.002), myocardial infarction (RR 0.68; 95% CI 0.56–0.82;
P
< 0.0001), and major adverse cardiac events (RR 0.71; 95% CI 0.53–0.94;
P
= 0.02) in patients with AF and diabetes. Moreover, rivaroxaban was associated with a lower risk of major bleeding (RR 0.79; 95% CI 0.65–0.96;
P
= 0.02), intracranial hemorrhage (RR 0.52; 95% CI 0.39–0.69;
P
< 0.00001), and major gastrointestinal bleeding (RR 0.74; 95% CI 0.56–0.98;
P
= 0.04). Similar results were obtained in stratified meta-analysis of cohort studies.
Conclusion
Our study suggests a favorable risk–benefit profile of rivaroxaban, with superior efficacy and safety over warfarin in patients with AF and diabetes.</description><identifier>ISSN: 1175-3277</identifier><identifier>EISSN: 1179-187X</identifier><identifier>DOI: 10.1007/s40256-020-00407-z</identifier><identifier>PMID: 32514866</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Anticoagulants ; Cardiac arrhythmia ; Cardiology ; Diabetes ; Drug interactions ; Embolisms ; Heart attacks ; Medicine ; Medicine & Public Health ; Meta-analysis ; Patients ; Pharmacology/Toxicology ; Pharmacotherapy ; Stroke ; Systematic Review</subject><ispartof>American journal of cardiovascular drugs : drugs, devices, and other interventions, 2021, Vol.21 (1), p.51-61</ispartof><rights>Springer Nature Switzerland AG 2020</rights><rights>Copyright Springer Nature B.V. Jan 2021</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-cbfb69011629f4d5ae96f7ac2f8579460373406e1fc49816f50d892f7dc7d0f73</citedby><cites>FETCH-LOGICAL-c375t-cbfb69011629f4d5ae96f7ac2f8579460373406e1fc49816f50d892f7dc7d0f73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40256-020-00407-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40256-020-00407-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32514866$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hua, Yang</creatorcontrib><creatorcontrib>Sun, Jin-Yu</creatorcontrib><creatorcontrib>Su, Yue</creatorcontrib><creatorcontrib>Qu, Qiang</creatorcontrib><creatorcontrib>Wang, Hong-Ye</creatorcontrib><creatorcontrib>Sun, Wei</creatorcontrib><creatorcontrib>Kong, Xiang-Qing</creatorcontrib><title>The Safety and Efficacy of Rivaroxaban Compared with Warfarin in Patients with Atrial Fibrillation and Diabetes: A Systematic Review and Meta-analysis</title><title>American journal of cardiovascular drugs : drugs, devices, and other interventions</title><addtitle>Am J Cardiovasc Drugs</addtitle><addtitle>Am J Cardiovasc Drugs</addtitle><description>Aims
This meta-analysis was conducted to compare the efficacy and safety of rivaroxaban with warfarin in patients with atrial fibrillation (AF) and diabetes mellitus.
Methods
PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched from the establishment of databases up to 15 October 2019. Studies on efficacy and safety outcomes of rivaroxaban and warfarin were included. Efficacy and safety outcomes, including stroke, ischemic stroke, stroke or systemic embolism, myocardial infarction, major adverse cardiac events, major bleeding, intracranial hemorrhage, and major gastrointestinal bleeding were collected for meta-analysis.
Results
Compared with warfarin, rivaroxaban could significantly reduce stroke (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.63–0.95;
P
= 0.01), ischemic stroke (RR 0.74; 95% CI 0.63–0.87;
P
= 0.0004), stroke or systemic embolism (RR 0.73; 95% CI 0.60–0.89;
P
= 0.002), myocardial infarction (RR 0.68; 95% CI 0.56–0.82;
P
< 0.0001), and major adverse cardiac events (RR 0.71; 95% CI 0.53–0.94;
P
= 0.02) in patients with AF and diabetes. Moreover, rivaroxaban was associated with a lower risk of major bleeding (RR 0.79; 95% CI 0.65–0.96;
P
= 0.02), intracranial hemorrhage (RR 0.52; 95% CI 0.39–0.69;
P
< 0.00001), and major gastrointestinal bleeding (RR 0.74; 95% CI 0.56–0.98;
P
= 0.04). Similar results were obtained in stratified meta-analysis of cohort studies.
Conclusion
Our study suggests a favorable risk–benefit profile of rivaroxaban, with superior efficacy and safety over warfarin in patients with AF and diabetes.</description><subject>Anticoagulants</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Diabetes</subject><subject>Drug interactions</subject><subject>Embolisms</subject><subject>Heart attacks</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Patients</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Stroke</subject><subject>Systematic Review</subject><issn>1175-3277</issn><issn>1179-187X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kd1u1DAQhS1ERUvhBbhAlrg2tR3_JNytlhaQWhX1R-XOmjg2dZVNtra3JX0QnrfupsAd0kge6XxzxpqD0DtGPzJK9UESlEtFKKeEUkE1eXiB9hjTDWG1_vFy20tSca130euUbihlmuvmFdqtuGSiVmoP_b64dvgcvMsThqHDh94HC3bCo8dn4Q7i-AtaGPByXK0hug7fh3yNryB6iGHApb5DDm7IaVYWOQbo8VFoY-j7Io3D1vdzgNZllz7hBT6fUnaroll85u6Cu98SJy4DgQH6KYX0Bu146JN7-_zuo8ujw4vlV3J8-uXbcnFMbKVlJrb1rWooY4o3XnQSXKO8Bst9LXUjFK10JahyzFvR1Ex5Sbu64V53VnfU62offZh913G83biUzc24ieUTyZTTCllLwepC8ZmycUwpOm_WMawgToZR8xSFmaMwJQqzjcI8lKH3z9abduW6vyN_bl-AagZSkYafLv7b_R_bR5wzlgA</recordid><startdate>2021</startdate><enddate>2021</enddate><creator>Hua, Yang</creator><creator>Sun, Jin-Yu</creator><creator>Su, Yue</creator><creator>Qu, Qiang</creator><creator>Wang, Hong-Ye</creator><creator>Sun, Wei</creator><creator>Kong, Xiang-Qing</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>2021</creationdate><title>The Safety and Efficacy of Rivaroxaban Compared with Warfarin in Patients with Atrial Fibrillation and Diabetes: A Systematic Review and Meta-analysis</title><author>Hua, Yang ; Sun, Jin-Yu ; Su, Yue ; Qu, Qiang ; Wang, Hong-Ye ; Sun, Wei ; Kong, Xiang-Qing</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-cbfb69011629f4d5ae96f7ac2f8579460373406e1fc49816f50d892f7dc7d0f73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anticoagulants</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Diabetes</topic><topic>Drug interactions</topic><topic>Embolisms</topic><topic>Heart attacks</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Patients</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Stroke</topic><topic>Systematic Review</topic><toplevel>online_resources</toplevel><creatorcontrib>Hua, Yang</creatorcontrib><creatorcontrib>Sun, Jin-Yu</creatorcontrib><creatorcontrib>Su, Yue</creatorcontrib><creatorcontrib>Qu, Qiang</creatorcontrib><creatorcontrib>Wang, Hong-Ye</creatorcontrib><creatorcontrib>Sun, Wei</creatorcontrib><creatorcontrib>Kong, Xiang-Qing</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>American journal of cardiovascular drugs : drugs, devices, and other interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hua, Yang</au><au>Sun, Jin-Yu</au><au>Su, Yue</au><au>Qu, Qiang</au><au>Wang, Hong-Ye</au><au>Sun, Wei</au><au>Kong, Xiang-Qing</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Safety and Efficacy of Rivaroxaban Compared with Warfarin in Patients with Atrial Fibrillation and Diabetes: A Systematic Review and Meta-analysis</atitle><jtitle>American journal of cardiovascular drugs : drugs, devices, and other interventions</jtitle><stitle>Am J Cardiovasc Drugs</stitle><addtitle>Am J Cardiovasc Drugs</addtitle><date>2021</date><risdate>2021</risdate><volume>21</volume><issue>1</issue><spage>51</spage><epage>61</epage><pages>51-61</pages><issn>1175-3277</issn><eissn>1179-187X</eissn><abstract>Aims
This meta-analysis was conducted to compare the efficacy and safety of rivaroxaban with warfarin in patients with atrial fibrillation (AF) and diabetes mellitus.
Methods
PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched from the establishment of databases up to 15 October 2019. Studies on efficacy and safety outcomes of rivaroxaban and warfarin were included. Efficacy and safety outcomes, including stroke, ischemic stroke, stroke or systemic embolism, myocardial infarction, major adverse cardiac events, major bleeding, intracranial hemorrhage, and major gastrointestinal bleeding were collected for meta-analysis.
Results
Compared with warfarin, rivaroxaban could significantly reduce stroke (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.63–0.95;
P
= 0.01), ischemic stroke (RR 0.74; 95% CI 0.63–0.87;
P
= 0.0004), stroke or systemic embolism (RR 0.73; 95% CI 0.60–0.89;
P
= 0.002), myocardial infarction (RR 0.68; 95% CI 0.56–0.82;
P
< 0.0001), and major adverse cardiac events (RR 0.71; 95% CI 0.53–0.94;
P
= 0.02) in patients with AF and diabetes. Moreover, rivaroxaban was associated with a lower risk of major bleeding (RR 0.79; 95% CI 0.65–0.96;
P
= 0.02), intracranial hemorrhage (RR 0.52; 95% CI 0.39–0.69;
P
< 0.00001), and major gastrointestinal bleeding (RR 0.74; 95% CI 0.56–0.98;
P
= 0.04). Similar results were obtained in stratified meta-analysis of cohort studies.
Conclusion
Our study suggests a favorable risk–benefit profile of rivaroxaban, with superior efficacy and safety over warfarin in patients with AF and diabetes.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32514866</pmid><doi>10.1007/s40256-020-00407-z</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1175-3277 |
| ispartof | American journal of cardiovascular drugs : drugs, devices, and other interventions, 2021, Vol.21 (1), p.51-61 |
| issn | 1175-3277 1179-187X |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Anticoagulants Cardiac arrhythmia Cardiology Diabetes Drug interactions Embolisms Heart attacks Medicine Medicine & Public Health Meta-analysis Patients Pharmacology/Toxicology Pharmacotherapy Stroke Systematic Review |
| title | The Safety and Efficacy of Rivaroxaban Compared with Warfarin in Patients with Atrial Fibrillation and Diabetes: A Systematic Review and Meta-analysis |
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