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Title: | Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis |
Author: | Bonanad, Clara García Blas, Sergio Torres Llergo, Javier Fernández Olmo, Rosa Díez Villanueva, Pablo Ariza Solé, Albert Martínez Sellés, Manuel Raposeiras, Sergio Ayesta, Ana Bertomeu González, Vicente Tarazona Santabalbina, Francisco Facila, Lorenzo Vivas, David Gabaldón Pérez, Ana Bodi, Vicente Nuñez, Julio Cordero, Alberto |
Keywords: | Persones grans Malalties coronàries Anticoagulants (Medicina) Infart de miocardi Older people Coronary diseases Anticoagulants (Medicine) Myocardial infarction |
Issue Date: | 12-Nov-2021 |
Publisher: | MDPI |
Abstract: | Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63-0.82; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70-0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69-1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76-1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36-0.60; p < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF. |
Note: | Reproducció del document publicat a: https://doi.org/10.3390/jcm10225268 |
It is part of: | Journal of Clinical Medicine, 2021, vol. 10, num. 22, p. 5268 |
URI: | http://hdl.handle.net/2445/183879 |
Related resource: | https://doi.org/10.3390/jcm10225268 |
ISSN: | 2077-0383 |
Appears in Collections: | Articles publicats en revistes (Ciències Clíniques) Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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