Safety and efficacy of reduced-dose non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

  • Wang KL & al.
  • Eur Heart J
  • 22 Dec 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Patients with atrial fibrillation (Afib) eligible for reduced-dose non-vitamin K antagonist oral anticoagulants (NOACs) were at higher risk for stroke or systemic embolism and major bleeding than those eligible for full-dose NOACs when treated with anticoagulants.
  • NOACs, when appropriately dose-adjusted, showed an improved benefit-harm profile compared with warfarin.

Why this matters

  • Findings highlight the importance of prescribing reduced-dose NOACs for right patient populations per approved clinical criteria.

Study design

  • Meta-analysis included 3 randomised controlled trials including 7351 patients eligible for reduced-dose NOACs from a total population of 46,426 patients for the analysis on stroke or systemic embolism.
  • Funding: Ministry of Health and Welfare and Ministry of Science and Technology, Taiwan.

Key results

  • Annualised rates for stroke or systemic embolism (2.70% [95% CI, 2.26-3.13%] vs 1.60% [95% CI, 1.36-1.85%] and major bleeding (4.35% [95% CI, 3.46-5.23%] vs 2.87% [95% CI, 2.47-3.27%] were higher in patients eligible for reduced-dose NOACs vs those eligible for full-dose.
  • Effects of reduced-dose NOACs vs warfarin in patients eligible for reduced-dose NOACs on stroke or systemic embolism (risk ratio [RR], 0.84; 95% CI, 0.69-1.03)] and on major bleeding (RR, 0.70; 95% CI, 0.50-0.97] were consistent with those of full-dose NOACs vs warfarin in those eligible for full-dose NOACs for stroke or systemic embolism (RR, 0.86; 95% CI, 0.77-0.96)  and for major bleeding (RR, 0.87; 95% CI, 0.70-1.08; P for interaction, 0.89 and 0.26, respectively).
  • Regardless of patient eligibility for NOAC dose reduction, NOACs were associated with reduced risks of haemorrhagic stroke, intracranial haemorrhage, fatal bleeding and death (P for interaction >0.05 for each).

Limitations

  • Heterogeneity among included studies.