Abstract | BACKGROUND: MATERIALS AND METHODS: We performed a trial-level meta-analysis of CAD subgroups from four trials of NOAC versus warfarin in patients with atrial fibrillation, comparing the primary trial endpoints (efficacy: stroke or systemic embolic event; safety: International Society on Thrombosis and Haemostasis major bleeding) in patients with versus those without CAD, and used interaction testing to assess for treatment effect modification. RESULTS: In total, 58,606 patients with established CAD were included in this meta-analysis. NOACs reduced the risk of stroke/systemic embolic event irrespective of presence of CAD (CAD: 0.76 (0.56-1.04); no CAD: hazard ratio 0.77 (0.56-1.06); p-INT 0.93). Similarly, there was no effect modification by presence of CAD for major bleeding (CAD: hazard ratio 0.92 (0.65-1.32), no CAD: 0.83 (0.61-1.12); p-INT 0.46) or myocardial infarction (CAD: hazard ratio 0.95 (0.62-1.44); no CAD: hazard ratio 0.95 (0.60-1.50); p-INT = 0.98). While NOACs reduced all-cause mortality in patients without CAD compared with warfarin (hazard ratio 0.85 (0.71-1.02)), there was no difference in mortality between NOACs and warfarin in the CAD group (hazard ratio 0.99 (0.82-1.20); p-INT 0.01). CONCLUSION: The present meta-analysis of four trials supports that NOACs are safe and at least as effective as warfarin in patients with atrial fibrillation and established CAD.
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Authors | Thomas A Zelniker, Christian T Ruff, Elliott M Antman, Robert P Giugliano |
Journal | European heart journal. Acute cardiovascular care
(Eur Heart J Acute Cardiovasc Care)
Vol. 8
Issue 6
Pg. 554-561
(Sep 2019)
ISSN: 2048-8734 [Electronic] England |
PMID | 30318902
(Publication Type: Journal Article, Meta-Analysis)
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Chemical References |
- Anticoagulants
- Factor Xa Inhibitors
- Pyridines
- Thiazoles
- Warfarin
- edoxaban
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Topics |
- Administration, Oral
- Aged
- Anticoagulants
(adverse effects, therapeutic use)
- Atrial Fibrillation
(drug therapy)
- Case-Control Studies
- Clinical Trials, Phase III as Topic
- Coronary Artery Disease
(complications, drug therapy)
- Factor Xa Inhibitors
(therapeutic use)
- Female
- Hemorrhage
(chemically induced, prevention & control)
- Humans
- Male
- Middle Aged
- Mortality
(trends)
- Myocardial Infarction
(etiology, prevention & control)
- Pyridines
(therapeutic use)
- Randomized Controlled Trials as Topic
- Safety
- Stroke
(epidemiology)
- Thiazoles
(therapeutic use)
- Treatment Outcome
- Warfarin
(adverse effects, therapeutic use)
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