Meta Analysis Of The Safety And Efficacy Of New Oral Anticoagulants In Elderly Patients With Non-valvular Atrial Fibrillation In China

Objective: To systematically evaluate the safety and efficacy of new oral anticoagulants(Dabigatran and Rivaroxaban)in the treatment of elderly patients with non-valvular atrial fibrillation in China.Methods: Pubmed,Medline,Cochrane Library,Web of science,EMBase,China knowledge net,China Biomedical Literature Database,Wanfang data and knowledge service platform were searched by computer to screen the randomized controlled study and parallel study on the efficacy of new oral anticoagulant(NOACs)and warfarin in the treatment of elderly patients with non-valvular atrial fibrillation in China.The literature was screened according to the inclusion criteria and exclusion criteria.According to the Cochrane collaboration network bias risk assessment criteria and the NOS scale,we independently assessed the quality of the literature.For the included randomized controlled studies,we used the Cochrane collaboration network bias risk assessment criteria,including the generation of random sequences,randomization hiding,blind method,and the explanation of the outcome.The NOS scale was used in the cohort study,which mainly included the selection of cohort,the comparability between groups and the results.The extraction of research data includes literature year,literature author,average age,CHA2DS2-VASc score and HASBLED score.The outcome indicators included 1 stroke or systemic embolism,2 severe bleeding and 3 non-severe bleeding.Finally,Meta analysis is carried out by using RevMan5.3 software.Results: A total of 7 cohort studies were included,with a total of 1082 patients,with a literature quality score of 5～8.The results of Meta analysis showed that the incidence of stroke or systemic embolism in elderly patients with non-valvular atrial fibrillation treated with rivaroxaban and dabigatran was lower than that of warfarin(P<0.05).There was no significant difference between rivaroxaban and dabigatran in the treatment of elderly patients with non-valvular atrial fibrillation(P>0.05).The incidences of severe and non-severe bleeding events in elderly patients with non-valvular atrial fibrillation treated with dabigatran and rivaroxaban were lower than those of warfarin(P<0.05),but there was no significant difference between rivaroxaban and dabigatran(P> 0.05).Conclusion: The efficacy and safety of new oral anticoagulants(Rivaroxaban and dabigatran)in the treatment of elderly patients with non-valvular atrial fibrillation in China are better than those of warfarin.NOACs can reduce the incidence of stroke,non-severe bleeding and severe bleeding in elderly patients with NVAF.