Department of Neurology, Veterans Health Service Medical Center, Seoul.
Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine.
Medicine (Baltimore). 2021 Aug 13;100(32):e26883. doi: 10.1097/MD.0000000000026883.
This study aimed to evaluate the comparative efficacy and safety of 4 non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in Asians with non-valvular atrial fibrillation in real-world practice through a network meta-analysis of observational studies.
We searched multiple comprehensive databases (PubMed, Embase, and Cochrane library) for studies published until August 2020. Hazard ratios and 95% confidence intervals were used for the pooled estimates. Efficacy outcomes included ischemic stroke (IS), stroke/systemic embolism (SSE), myocardial infarction (MI), and all-cause mortality, and safety outcomes included major bleeding, gastrointestinal (GI) bleeding, and intracerebral hemorrhage (ICH). The P score was calculated for ranking probabilities. Subgroup analyses were separately performed in accordance with the dosage range of NOACs ("standard-" and "low-dose").
A total of 11, 6, and 8 studies were allocated to the total population, standard-dose group, and low-dose group, respectively. In the total study population, edoxaban ranked the best in terms of IS and ICH prevention and apixaban ranked the best for SSE, major bleeding, and GI bleeding. In the standard-dose regimen, apixaban ranked the best in terms of IS and SSE prevention. For major bleeding, GI bleeding, and ICH, edoxaban ranked the best. In the low-dose regimen, edoxaban ranked the best for IS, SSE, GI bleeding, and ICH prevention. For major bleeding prevention, apixaban ranked best.
All 4 NOACs had different efficacy and safety outcomes according to their type and dosage. Apixaban and edoxaban might be relatively better and more well-balanced treatment for Asian patients with non-valvular atrial fibrillation.
本研究旨在通过对观察性研究的网络荟萃分析，评估 4 种非维生素 K 拮抗剂口服抗凝剂（NOACs）与华法林在亚洲非瓣膜性心房颤动患者中的疗效和安全性。
我们检索了多个综合数据库（PubMed、Embase 和 Cochrane 图书馆），检索截至 2020 年 8 月发表的研究。使用合并估计的风险比和 95%置信区间。疗效结局包括缺血性卒中（IS）、卒中/全身性栓塞（SSE）、心肌梗死（MI）和全因死亡率，安全性结局包括大出血、胃肠道（GI）出血和颅内出血（ICH）。计算 P 评分进行排名概率。根据 NOAC 的剂量范围（“标准-”和“低剂量”）分别进行亚组分析。
共有 11、6 和 8 项研究分别纳入总人群、标准剂量组和低剂量组。在总研究人群中，依度沙班在预防 IS 和 ICH 方面排名最佳，阿哌沙班在预防 SSE、大出血和 GI 出血方面排名最佳。在标准剂量方案中，阿哌沙班在预防 IS 和 SSE 方面排名最佳。对于大出血、GI 出血和 ICH，依度沙班排名最佳。在低剂量方案中，依度沙班在预防 IS、SSE、GI 出血和 ICH 方面排名最佳。对于预防大出血，阿哌沙班排名最佳。
根据类型和剂量，4 种 NOACs 的疗效和安全性结果不同。阿哌沙班和依度沙班可能是亚洲非瓣膜性心房颤动患者更优、更均衡的治疗选择。
