Open AccessThe Efficacy and Safety of Edoxaban versus Warfarin in Prevention of Clinical Events in Atrial Fibrillation: A Systematic Review and Meta-analysis
Author(s) -
Ming Liu
Publication year - 2020
Publication title -
the anatolian journal of cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.364
H-Index - 28
eISSN - 2149-2271
pISSN - 2149-2263
DOI - 10.14744/anatoljcardiol.2020.18049
Subject(s) - edoxaban , medicine , warfarin , atrial fibrillation , stroke (engine) , incidence (geometry) , relative risk , hazard ratio , myocardial infarction , cardiology , adverse effect , randomized controlled trial , major bleeding , confidence interval , dabigatran , mechanical engineering , physics , optics , engineering
Atrial fibrillation (AF) is the most common type of arrhythmia. Warfarin reduces the incidence and mortality of strokes in patients with AF. Edoxaban reduces the bleeding risk in patients with AF. This study evaluates the efficacy and safety of edoxaban versus warfarin in preventing clinical events in patients with AF through a meta-analysis of randomized controlled trials (RCTs). RCTs were retrieved from medical literature databases. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the primary and safety endpoints. In total, five articles (10 trial comparisons) containing 24,836 patients were retrieved. Of these patients, 16,268 (65.5%) received edoxaban and 8,568 (34.5%) received warfarin. Compared with warfarin, edoxaban significantly reduced the incidence of cardiovascular death (CVD), major bleeding, and non-major bleeding (RR: 0.86, 95% CI: 0.80-0.93, I2 : 0.0%; RR: 0.65, 95% CI: 0.59-0.71, I2 : 75.6%; and RR: 0.80, 95% CI: 0.77-0.84, I2 : 79.3%, respectively). Edoxaban did not increase the incidence of stroke, systemic embolic events, myocardial infarction, and adverse events compared with warfarin (RR: 1.00, 95% CI: 0.90-1.11, I2 : 42.8%; RR: 1.00, 95% CI: 0.67-1.49, I2 : 0.0%; RR: 1.08, 95% CI: 0.93-1.27, I2 : 0.0%; RR: 1.00, 95% CI: 0.91-1.10, I2: 46.4%, respectively). This meta-analysis indicated that compared with warfarin, edoxaban can significantly reduce the incidence of CVD and major and non-major bleeding. The anticoagulant effect and safety of edoxaban may be better than those of warfarin.