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Comparing mortality in patients with atrial fibrillation who are receiving a direct‐acting oral anticoagulant or warfarin: a meta‐analysis of randomized trials
Author(s) -
Liew A.,
O'Donnell M.,
Douketis J.
Publication year - 2014
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.12651
Subject(s) - medicine , warfarin , stroke (engine) , atrial fibrillation , number needed to treat , relative risk , randomized controlled trial , confidence interval , meta analysis , surgery , mechanical engineering , engineering
Summary Background In patients with non‐valvular atrial fibrillation ( AF ), direct‐acting oral anticoagulants ( DOAC s) 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 A meta‐analysis was performed on phase 3 randomized trials that compared a DOAC with warfarin for stroke prevention in AF . Published data were pooled by use of the DerSimonian random‐effect model, with revman 5.2 and comprehensive meta analysis software version 2. The results were presented as risk ratios ( RR s), absolute risk reduction ( ARR ), and number‐needed‐to‐treat ( NNT ). Results A total of 71 683 patients were included in this meta‐analysis from four randomized controlled trials (median patient follow‐up: 1.8–2.8 years) that compared a DOAC with warfarin for stroke prevention in AF . As compared with warfarin, DOAC s significantly reduced all‐cause mortality ( RR 0.89, 95% confidence interval [ 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 As compared with warfarin therapy for stroke prevention in patients with AF , DOAC s significantly reduce all‐cause mortality, vascular mortality, and bleeding mortality. This mortality benefit appears to be driven by the reduction in vascular‐related and bleeding‐related mortality, which, in turn, may be related to the reduction in intracranial bleeding.