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Mortality outcomes in patients receiving direct oral anticoagulants: a systematic review and meta‐analysis of randomized controlled trials
Author(s) -
ChaiAdisaksopha C.,
Hillis C.,
Isayama T.,
Lim W.,
Iorio A.,
Crowther M.
Publication year - 2015
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.13139
Subject(s) - medicine , warfarin , atrial fibrillation , randomized controlled trial , case fatality rate , vitamin k antagonist , mortality rate , surgery , epidemiology
Summary Background Direct oral anticoagulants ( DOAC s) are widely used as an alternative for warfarin. However, the impact of DOAC s on mortality outcomes compared with warfarin remains unclear. Objective To estimate the mortality outcomes in patients treated with DOAC s vs. warfarin (or another vitamin K antagonist). Methods MEDLINE , EMBASE and CENTRAL databases (inception to September 2014), conference abstracts and www.clinicaltrials.gov , were searched, without language restriction. Studies were selected if there were phase III , randomized trials comparing DOAC s with warfarin in patients with non‐valvular atrial fibrillation or venous thromboembolism. Results Thirteen randomized controlled trials involving 102 707 adult patients were included in the analysis. The case‐fatality rate of major bleeding was 7.57% (95% CI , 6.53–8.68; I 2 = 0%) in patients taking DOAC s and 11.04% (95% CI , 9.16–13.07; I 2 = 33.3%) in patients taking warfarin. The rate of fatal bleeding in adult patients receiving DOAC s was 0.16 per 100 patient‐years (95% CI , 0.12–0.20; I 2 = 36.5%). When compared with warfarin, DOAC s were associated with significant reductions in fatal bleeding ( RR , 0.53; 95% CI , 0.43–0.64; I 2 = 0%), cardiovascular mortality ( RR , 0.88; 95% CI , 0.82–0.94; I 2 = 0%) and all‐cause mortality ( RR , 0.91; 95% CI , 0.87–0.96; I 2 = 0%). Conclusions The use of DOAC s compared with warfarin is associated with a lower rate of fatal bleeding, case‐fatality rate of major bleeding, cardiovascular mortality and all‐cause mortality.