ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology
Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis [Anatol J Cardiol]
Anatol J Cardiol. 2022; 26(6): 424-433 | DOI: 10.5152/AnatolJCardiol.2022.1376

Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis

Zei Li1, Yingming Zheng1, Dandan Li1, Xiaozhen Wang2, Sheng Cheng1, Xiao Luo1, Aiping Wen1
1Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
2Central Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China

Background: The meta-analysis of randomized controlled trials has illustrated that the efficacy of low-dose non-vitamin K antagonist oral anticoagulants is inferior compared with standard-dose non-vitamin K antagonist oral anticoagulants, though they are still frequently prescribed for Asian patients with non-valvular atrial fibrillation. We aimed to further investigate the efficacy and safety of low-dose non-vitamin K antagonist oral anticoagulants by carrying out a meta-analysis of all relevant randomized controlled trials and cohort studies.

Methods: Cochrane Central Register of Controlled Trials, Embase, and MEDLINE were systematically searched from the inception to September 9, 2021, for randomized controlled trials or cohorts that compared the efficacy and/or safety of low-dose non-vitamin K antagonist oral anticoagulants in Asian patients with non-valvular atrial fibrillation. The primary outcomes were stroke and major bleeding, and the secondary outcomes were mortality, intracranial hemorrhage, and gastrointestinal hemorrhage. Hazard ratios and 95% CIs were estimated using the random-effect model.

Results: Nineteen publications involving 371 574 Asian patients with non-valvular atrial fibrillation were included. Compared with standard-dose non-vitamin K antagonist oral anticoagulants, low-dose non-vitamin K antagonist oral anticoagulants showed comparable risks of stroke (hazard ratio, 1.18; 95% CI 0.98 to 1.42), major bleeding (hazard ratio, 1.00; 95% CI 0.83 to 1.21), intracranial hemorrhage (hazard ratio, 1.13; 95% CI 0.92 to 1.38), and gastrointestinal hemorrhage (hazard ratio, 1.07; 95% CI 0.87 to 1.31), though had a higher risk of mortality (hazard ratio, 1.34; 95% CI 1.05 to 1.71). Compared with warfarin, low-dose non-vitamin K antagonist oral anticoagulants were associated with lower risks of stroke (hazard ratio, 0.73; 95% CI 0.67 to 0.79), mortality (hazard ratio, 0.69; 95% CI 0.60 to 0.81), major bleeding (hazard ratio, 0.62; 95% CI 0.51 to 0.75), intracranial hemorrhage (hazard ratio, 0.48; 95% CI 0.33 to 0.69), and gastrointestinal hemorrhage (hazard ratio, 0.78; 95% CI 0.65 to 0.93).

Conclusion: Low-dose non-vitamin K antagonist oral anticoagulants were superior to warfarin, and comparable to standard-dose non-vitamin K antagonist oral anticoagulants considering risks of stroke, major bleeding, intracranial hemorrhage, and gastrointestinal hemorrhage. Further, high qualified studies are warranted.

Keywords: Atrial fibrillation, NOACs, warfarin, meta-analysis

Zei Li, Yingming Zheng, Dandan Li, Xiaozhen Wang, Sheng Cheng, Xiao Luo, Aiping Wen. Low-Dose NOACs Versus Standard-Dose NOACs or Warfarin on Efficacy and Safety in Asian Patients with NVAF: A Meta-Analysis. Anatol J Cardiol. 2022; 26(6): 424-433

Corresponding Author: Zei Li
Manuscript Language: English


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