Effectiveness and safety of non-vitamin K oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke: A systematic review and meta-analysis

Minglei Shi*, Lu Liu, Hatem Wafa, Vasa Curcin, Yanzhong Wang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Downloads (Pure)

Abstract

Introduction: Current evidence regarding the clinical outcomes of non-vitamin K oral anticoagulants (NOACs) versus warfarin in patients with atrial fibrillation (AF) and previous stroke is inconclusive, especially in patients with previous intracranial haemorrhage (ICrH). We aim to undertake a systematic review and meta-analysis assessing the effectiveness and safety of NOACs versus warfarin in AF patients with a history of stroke. 


Methods: We searched studies published up to December 10, 2022, on PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials. Studies on adults with AF and previous ischaemic stroke (IS) or IrCH receiving either NOACs or warfarin and capturing outcome events (thromboembolic events, ICrH, and all-cause mortality) were eligible for inclusion. 


Results: Six randomized controlled trials (RCTs) (including 19,489 patients with previous IS) and fifteen observational studies (including 132,575 patients with previous IS and 13,068 patients with previous ICrH) were included. RCT data showed that compared with warfarin, NOACs were associated with a significant reduction in thromboembolic events (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.75-0.96), ICrH (OR: 0.57, 95% CI: 0.36-0.90), and all-cause mortality (OR: 0.88, 95% CI: 0.80-0.98). In analysing observational studies, similar results were retrieved. Moreover, patients with previous ICrH had a lower OR on thromboembolic events than those with IS (OR: 0.66, 95% CI: 0.46-0.95 vs. OR: 0.80, 95% CI: 0.70-0.93) in the comparison between NOACs and warfarin. 


Conclusions: Observational data showed that in AF patients with previous stroke, NOACs showed better clinical performance compared to warfarin and the benefits of NOACs were more pronounced in patients with previous IrCH versus those with IS. RCT data also showed NOACs are superior to warfarin. However, current RCTs only included AF patients who survived an IS, and further large RCTs focused on patients with previous ICrH are warranted.

Original languageEnglish
Pages (from-to)1-14
Number of pages14
JournalNeuroepidemiology
Volume58
Issue number1
Early online date17 Oct 2023
DOIs
Publication statusPublished - 2 Feb 2024

Fingerprint

Dive into the research topics of 'Effectiveness and safety of non-vitamin K oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke: A systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this