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Comparing Mortality in Patients with Atrial Fibrillation who are Receiving a Direct Oral Anticoagulant or Warfarin: A Meta-analysis of Randomized Trials.
J Thromb Haemost. 2014 Jul 1;
Authors: Liew A, O'Donnell M, Douketis J
Abstract
BACKGROUND: In patients with nonvalvular atrial fibrillation (AF), direct oral anticoagulants (DOACs) are at least non-inferior to warfarin for the prevention of stroke and systemic embolism. The main objective of this study was to obtain reliable and precise estimates for all-cause mortality, vascular mortality and bleeding mortality in patients with AF receiving a DOAC or warfarin for stroke prevention.
METHODS: Meta-analysis was performed on phase 3 randomized trials which compared a DOAC with warfarin for stroke prevention in AF. Published data was pooled using the DerSimonian random-effect model using Revman 5.2 and Comprehensive Meta Analysis software version 2. The results were presented as risk ratios (RR), absolute risk reduction (ARR) and number-needed-to-treat (NNT).
RESULTS: A total of 71,683 patients were included in this meta-analysis from 4 randomized controlled trials (median patient follow-up: 1.8 to 2.8 years) which compared a DOAC with warfarin for stroke prevention in AF. When compared with warfarin, DOACs significantly reduced all-cause mortality (RR: 0.89; 95% CI: 0.85-0.94; ARR: 0.76%; 95% CI: 0.39-1.13%; NNT = 132), vascular mortality (RR: 0.88; 95% CI: 0.82-0.94; ARR: 0.53%; 95% CI: 0.23-0.83%; NNT=189), and bleeding mortality (RR: 0.54; 95% CI: 0.44-0.67; ARR: 0.32%; 95% CI: 0.21-0.43%; NNT=313).
CONCLUSION: Compared with warfarin therapy for stroke prevention in patients with AF, DOACs significantly reduce all-cause mortality, vascular mortality and bleeding mortality. This mortality benefit appears to be driven by the reduction in vascular- and bleeding-related mortality which, in turn, may be related to the reduction in intracranial bleeding. This article is protected by copyright. All rights reserved.
PMID: 24986568 [PubMed - as supplied by publisher]