Recent observational studies have compared the safety and efficacy profiles between non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in patients with atrial fibrillation (AFib). However, confounders may exist due to the nature of clinical practice-based data, thus potentially influencing the reliability of results.
Researchers conducted a systematic review and meta-analysis to compare the effect of NOACs with warfarin based on the propensity score-based observational studies vs. randomized clinical trials (RCTs). The results were published in Frontiers in Cardiovascular Medicine.
This study analyzed 20 propensity score-based observational studies and 4 RCTs which were obtained by systematically searching the PubMed and EMBASE databases. The primary endpoints were defined as stroke or systemic embolism (SSE) and major bleeding.
According to the results, compared with warfarin, dabigatran (HR, 0.82 [95% CI, 0.71-0.96]), rivaroxaban (HR, 0.80 [95% CI, 0.75-0.85]), apixaban (HR, 0.75 [95% CI, 0.65-0.86]), and edoxaban (HR, 0.71 [95% CI, 0.60-0.83]) were associated with a reduced risk of stroke or systemic embolism, whereas dabigatran (HR, 0.76 [95% CI, 0.65-0.87]), apixaban (HR, 0.61 [95% CI, 0.56-0.67]), and edoxaban (HR, 0.58 [95% CI, 0.45-0.74]) but not rivaroxaban (HR, 0.92 [95% CI, 0.84-1.00]) were significantly associated with a decreased risk of major bleeding based on the observational studies. Moreover, the study found that the risk of major bleeding with dabigatran 150 mg was appreciably lower in observational studies.
“Data from propensity score-based observational studies and NOAC trials consistently suggest that the use of four individual NOACs is non-inferior to warfarin for stroke prevention in AF patients,” the researchers concluded.