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ISSN 2448-5640 (Print)
Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2019, Number 2

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Cir Card Mex 2019; 4 (2)

Safety of anticoagulant therapy for patients with atrial fibrillation: a systematic review and meta-analysis

Dong L, Hu A, Wang J, Liu T, Zou C, Wang X

Language: English
References: 38
Page: 35-47
PDF size: 717.20 Kb.


ABSTRACT

Background. Anticoagulants are recommended in patients with atrial fibrillation (AF). However, many patients chose antiplatelet therapy or did not take any therapy owing to bleeding risk. Major bleeding events (MBE) can be the origin of poor prognosis. Objectives. We sought to explore the safety of anticoagulants by analyzing the differences of the incidence of MBE and vascular death events (VDE) in patients with AF. Methods. Three databases were searched from inception to November 30, 2017. Fifteen randomized controlled trials (RCTs) were included in this study. Results. Compared with placebo (risk ratio [RR] 1.95, 95% confidence interval [CI] 0.87- 4.38, p = 0.11), although warfarin increased the risk of bleeding events (warfarin vs aspirin: RR 1.86, 95% CI 1.30-2.65, p = 0.0006), the risk was not higher with greater treatment intensity. In addition, warfarin did not increase the risks in MBE (warfarin vs aspirin: RR 1.08, 95% CI 0.71-1.64, p = 0.72; warfarin vs placebo RR 2.27, 95% CI 0.84-6.15, p = 0.11). Moreover, a significantly decreased risks of VDE were shown in the standard plus high intensity warfarin group (warfarin vs aspirin: RR 0.44, 95% CI 0.25-0.76, p = 0.004; warfarin vs placebo: RR 0.30, 95% CI 0.13-0.71, p = 0.005). Only one study demonstrated that compared with aspirin, apixaban did not rise the incidence of MBE (p=0.57) and it had a decreased mortality trend (P=0.07). Conclusions. It is safe to use anticoagulants in patients with AF. In addition, the warfarin dose should not be too conservative.


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