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New oral anticoagulants for nonvalvular atrial fibrillation with stable coronary artery disease: A meta‐analysis
Author(s) -
Cen Zhifu,
Meng Qiuyu,
Cui Kaijun
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14081
Subject(s) - medicine , atrial fibrillation , cardiology , coronary artery disease , meta analysis
Background New oral anticoagulants (NOACs) are effective and safe in patients with nonvalvular atrial fibrillation (NVAF). Limited evidence is available regarding outcomes for NVAF patients with stable coronary artery disease (CAD). Methods A systematic search of Medline, Embase, and the Cochrane Register was performed. Two reviewers independently performed data extraction and quality assessment using the Cochrane Collaboration risk‐of‐bias assessment tool. We evaluated all primary publications and secondary analyses comparing NOACs with any other OAC agent for preventing stroke in patients with both NVAF and stable CAD from phase III clinical randomized control trials. The primary outcomes were stroke, systemic embolism (SE), major bleeding, and intracranial hemorrhage (ICH), and the secondary outcomes were cardiovascular (CV) death, all‐cause death, and myocardial infarction (MI). Results Four articles with a total of 19 266 patients were included in this study. The pooled results showed a relative risk for stroke/SE with NOACs of 0.83 (95% confidence interval [CI]: 0.71‐0.97), for major bleeding 0.85 (95% CI: 0.63‐1.14), for ICH 0.36 (95% CI: 0.19‐0.54), for MI 1.00 (95% CI: 0.82‐1.20), for CV death 0.94 (95% CI: 0.83‐1.06), and for all‐cause death 0.95 (95% CI: 0.85‐1.07). Conclusion NOACs were effective in preventing stroke/SE and reducing the risk of ICH in patients with both NVAF and CAD.