Non-Vitamin K Antagonist Oral Anticoagulants in Secondary Stroke Prevention in Atrial Fibrillation Patients: An Updated Analysis by Adding Observational Studies
Background This meta-analysis aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in secondary stroke prevention in atrial fibrillation (AF) patients. Methods PubMed and Embase electronic databases were systematically...
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| Veröffentlicht in: | Cardiovascular drugs and therapy 2020-08, Vol.34 (4), p.569-578 |
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| creator | Liu, Xin Xu, Zi-Xuan Yu, Peng Yuan, Ping Zhu, Wen-Gen |
| description | Background
This meta-analysis aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in secondary stroke prevention in atrial fibrillation (AF) patients.
Methods
PubMed and Embase electronic databases were systematically searched from January 2009 to July 2019 for relevant randomized clinical trials and observational studies. A random-effects model was applied in the pooled analysis.
Results
A total of 14 studies (4 randomized clinical trials and 10 observational studies) were included. Based on the randomized clinical trials, compared with VKA use, the use of NOACs was associated with decreased risk of stroke and systemic embolism, major bleeding, and intracranial bleeding. Based on the observational studies, compared with VKAs, the subgroup analysis showed that dabigatran and rivaroxaban were associated with a reduced risk of stroke or systemic embolism, whereas dabigatran and apixaban were associated with a decreased risk of major bleeding.
Conclusion
Based on current data, the use of NOACs is at least non-inferior to the use of VKAs in AF patients for secondary stroke prevention irrespective of NOAC type. |
| doi_str_mv | 10.1007/s10557-020-06961-7 |
| format | Article |
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This meta-analysis aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in secondary stroke prevention in atrial fibrillation (AF) patients.
Methods
PubMed and Embase electronic databases were systematically searched from January 2009 to July 2019 for relevant randomized clinical trials and observational studies. A random-effects model was applied in the pooled analysis.
Results
A total of 14 studies (4 randomized clinical trials and 10 observational studies) were included. Based on the randomized clinical trials, compared with VKA use, the use of NOACs was associated with decreased risk of stroke and systemic embolism, major bleeding, and intracranial bleeding. Based on the observational studies, compared with VKAs, the subgroup analysis showed that dabigatran and rivaroxaban were associated with a reduced risk of stroke or systemic embolism, whereas dabigatran and apixaban were associated with a decreased risk of major bleeding.
Conclusion
Based on current data, the use of NOACs is at least non-inferior to the use of VKAs in AF patients for secondary stroke prevention irrespective of NOAC type.</description><identifier>ISSN: 0920-3206</identifier><identifier>EISSN: 1573-7241</identifier><identifier>DOI: 10.1007/s10557-020-06961-7</identifier><identifier>PMID: 32297024</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Antagonists ; Anticoagulants ; Bleeding ; Cardiac arrhythmia ; Cardiology ; Clinical trials ; Embolism ; Embolisms ; Fibrillation ; Health risks ; Medicine ; Medicine & Public Health ; Observational studies ; Phylloquinone ; Prevention ; Randomization ; Review Article ; Risk management ; Stroke ; Subgroups ; Vitamin K</subject><ispartof>Cardiovascular drugs and therapy, 2020-08, Vol.34 (4), p.569-578</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-199fc69ed9609831d0394de4aecbe8a579f5b176401c6db9843095dca1e7b9c63</citedby><cites>FETCH-LOGICAL-c375t-199fc69ed9609831d0394de4aecbe8a579f5b176401c6db9843095dca1e7b9c63</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/s10557-020-06961-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10557-020-06961-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32297024$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Xin</creatorcontrib><creatorcontrib>Xu, Zi-Xuan</creatorcontrib><creatorcontrib>Yu, Peng</creatorcontrib><creatorcontrib>Yuan, Ping</creatorcontrib><creatorcontrib>Zhu, Wen-Gen</creatorcontrib><title>Non-Vitamin K Antagonist Oral Anticoagulants in Secondary Stroke Prevention in Atrial Fibrillation Patients: An Updated Analysis by Adding Observational Studies</title><title>Cardiovascular drugs and therapy</title><addtitle>Cardiovasc Drugs Ther</addtitle><addtitle>Cardiovasc Drugs Ther</addtitle><description>Background
This meta-analysis aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in secondary stroke prevention in atrial fibrillation (AF) patients.
Methods
PubMed and Embase electronic databases were systematically searched from January 2009 to July 2019 for relevant randomized clinical trials and observational studies. A random-effects model was applied in the pooled analysis.
Results
A total of 14 studies (4 randomized clinical trials and 10 observational studies) were included. Based on the randomized clinical trials, compared with VKA use, the use of NOACs was associated with decreased risk of stroke and systemic embolism, major bleeding, and intracranial bleeding. Based on the observational studies, compared with VKAs, the subgroup analysis showed that dabigatran and rivaroxaban were associated with a reduced risk of stroke or systemic embolism, whereas dabigatran and apixaban were associated with a decreased risk of major bleeding.
Conclusion
Based on current data, the use of NOACs is at least non-inferior to the use of VKAs in AF patients for secondary stroke prevention irrespective of NOAC type.</description><subject>Antagonists</subject><subject>Anticoagulants</subject><subject>Bleeding</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Clinical trials</subject><subject>Embolism</subject><subject>Embolisms</subject><subject>Fibrillation</subject><subject>Health risks</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Observational studies</subject><subject>Phylloquinone</subject><subject>Prevention</subject><subject>Randomization</subject><subject>Review Article</subject><subject>Risk management</subject><subject>Stroke</subject><subject>Subgroups</subject><subject>Vitamin K</subject><issn>0920-3206</issn><issn>1573-7241</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc1uEzEUhS1ERUPLC7BAltiwGfDPzHjMLqpaQFRNpVC2I499E7lM7GB7KuVteFRukgISi66u7fudc20fQl5z9p4zpj5kzppGVUywirW65ZV6Rma8UbJSoubPyYxpbEnB2lPyMud7hiKtuxfkVAqhFRP1jPy6iaH67ovZ-EC_0nkoZh2Dz4Uukhn3e2-jWU-jCSVTZJZgY3Am7eiypPgD6G2CB0Ashn17XpJH3ZUfkh9Hczi-xYJE_oh29G7rTAGHSzPuss902NG5cz6s6WLIkB4OGrRYlsl5yOfkZGXGDK8e6xm5u7r8dvG5ul58-nIxv66sVE2puNYr22pwumW6k9wxqWsHtQE7QGcapVfNwFVbM25bN-iulkw3zhoOatC2lWfk3dF3m-LPCXLpNz5bwDcEiFPuhdSsbbjkNaJv_0Pv45TwzkjVXKsO0xFIiSNlU8w5warfJr_Bj-s56_f59cf8esyvP-TXKxS9ebSehg24v5I_gSEgj0DGVlhD-jf7CdvfrJWnoQ</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Liu, Xin</creator><creator>Xu, Zi-Xuan</creator><creator>Yu, Peng</creator><creator>Yuan, Ping</creator><creator>Zhu, Wen-Gen</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20200801</creationdate><title>Non-Vitamin K Antagonist Oral Anticoagulants in Secondary Stroke Prevention in Atrial Fibrillation Patients: An Updated Analysis by Adding Observational Studies</title><author>Liu, Xin ; Xu, Zi-Xuan ; Yu, Peng ; Yuan, Ping ; Zhu, Wen-Gen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-199fc69ed9609831d0394de4aecbe8a579f5b176401c6db9843095dca1e7b9c63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Antagonists</topic><topic>Anticoagulants</topic><topic>Bleeding</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Clinical trials</topic><topic>Embolism</topic><topic>Embolisms</topic><topic>Fibrillation</topic><topic>Health risks</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Observational studies</topic><topic>Phylloquinone</topic><topic>Prevention</topic><topic>Randomization</topic><topic>Review Article</topic><topic>Risk management</topic><topic>Stroke</topic><topic>Subgroups</topic><topic>Vitamin K</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Xin</creatorcontrib><creatorcontrib>Xu, Zi-Xuan</creatorcontrib><creatorcontrib>Yu, Peng</creatorcontrib><creatorcontrib>Yuan, Ping</creatorcontrib><creatorcontrib>Zhu, Wen-Gen</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</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>Engineering Research Database</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>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Cardiovascular drugs and therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Xin</au><au>Xu, Zi-Xuan</au><au>Yu, Peng</au><au>Yuan, Ping</au><au>Zhu, Wen-Gen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-Vitamin K Antagonist Oral Anticoagulants in Secondary Stroke Prevention in Atrial Fibrillation Patients: An Updated Analysis by Adding Observational Studies</atitle><jtitle>Cardiovascular drugs and therapy</jtitle><stitle>Cardiovasc Drugs Ther</stitle><addtitle>Cardiovasc Drugs Ther</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>34</volume><issue>4</issue><spage>569</spage><epage>578</epage><pages>569-578</pages><issn>0920-3206</issn><eissn>1573-7241</eissn><abstract>Background
This meta-analysis aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in secondary stroke prevention in atrial fibrillation (AF) patients.
Methods
PubMed and Embase electronic databases were systematically searched from January 2009 to July 2019 for relevant randomized clinical trials and observational studies. A random-effects model was applied in the pooled analysis.
Results
A total of 14 studies (4 randomized clinical trials and 10 observational studies) were included. Based on the randomized clinical trials, compared with VKA use, the use of NOACs was associated with decreased risk of stroke and systemic embolism, major bleeding, and intracranial bleeding. Based on the observational studies, compared with VKAs, the subgroup analysis showed that dabigatran and rivaroxaban were associated with a reduced risk of stroke or systemic embolism, whereas dabigatran and apixaban were associated with a decreased risk of major bleeding.
Conclusion
Based on current data, the use of NOACs is at least non-inferior to the use of VKAs in AF patients for secondary stroke prevention irrespective of NOAC type.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32297024</pmid><doi>10.1007/s10557-020-06961-7</doi><tpages>10</tpages></addata></record> |
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| ispartof | Cardiovascular drugs and therapy, 2020-08, Vol.34 (4), p.569-578 |
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| subjects | Antagonists Anticoagulants Bleeding Cardiac arrhythmia Cardiology Clinical trials Embolism Embolisms Fibrillation Health risks Medicine Medicine & Public Health Observational studies Phylloquinone Prevention Randomization Review Article Risk management Stroke Subgroups Vitamin K |
| title | Non-Vitamin K Antagonist Oral Anticoagulants in Secondary Stroke Prevention in Atrial Fibrillation Patients: An Updated Analysis by Adding Observational Studies |
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