Comparison Of The Safety And Efficacy Of New Oral Anticoagulants With Warfarin In Patients With Atrial Fibrillation:A Meta-analysis

BackgroundAtrial fibrillation is one of the most common arrhythmias. AF is the independent risk factor in stroke, with high death rate and morbidity. The formation of thrombus also can cause pulmonary embolism and myocardial infarction. However standard anticoagulation therapy can significantly prevent stroke or systemic embolism. Warfarin is the most widely used drug in atrial fibrillation patients in the clinical. But due to the individual differences, we need to observe the hemostatic index to adjust the dose of drug during the process. So the use of warfarin is restricted to some extent. new oral anticoagulant drugs, including Dabigatran etexilate, Apixaban, Rivaroxaban, Edoxaban, have the characteristics of stability effective, high safety and convenient administered. In recent years, clinical studies in abroad showed that new oral anticoagulants is better than warfarin in the prevention of bleeding in patients with non-valvular atrial fibrillation. But it may bring the dangerous of gastrointestinal bleeding, also there is no consistent advices in the prevention of stroke or systemic embolism.ObjectiveThe intend of this research is to explore the comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with non-valvular atrial fibrillation. Providing evidence-based medical evidence for the clinical rational drug use in the future.MethodWe searched studies in the electronic databases including CNKI, WANFANG, VIP, Pubmed, Medline, Cochrane Library. Searching the related literatures about comparison of safety and efficacy of new oral anticoagulant drugs with warfarin. Quality assessment was investigated according to the design, rate of stroke, death rate, risk of bleeding, odds ratio (OR), risk ratio (RR), and 95% confidence interval (95%CI) were calculated using the fixed-effects and random-effects.ResultsIn this study,8 trials were analyzed. Five trials were RCTs, and the others were Retrospective study. The quality assessments results showed:four studies were enrolled 6, one study was enrolled 5, three studies was enrolled 4. Systematic analysis showed that NOAC could reduce the rate of stroke significantly (RR=0.83, 95%CI (0.71,0.97), p=0.02); the incidence rate of Miocardial infarction was not significant between NOAC and warfarin (RR=0.82,95%CI (0.57,1.17), p =0.27);NOAC could reduce the death rate(RR=0.90,95%CI(0.85,0.96),p=0.001); About safety, NOAC could significant reduce the risk of major bleeding events (RR=0.79,95%CI (0.74,0.85), p,0.00001) and minor bleeding events (RR=0.87, 95%CI (0.76,0.99), p=0.03)ConclusionsMeta-analysis showed the NOAC were associated with a significant reduce of the risk of stroke, death rate and bleeding rate. Our findings offer clinical a more comprehensive picture of the new oral anticoagulants as a therapeutic option to reduce the risk of stroke in patients with non-valvular atrial fibrillation.