Net clinical benefit of a reduced dose of DOACs in non-valvular atrial fibrillation: A meta-analysis of randomized trials.

Autor: Thomopoulos C; Department of Cardiology, Helena Venizelou Hospital, Athens, Greece., Ntalakouras J; First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece., Polyzos D; First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece., Konstantinidis D; First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece., Palaiodimou L; Second Department of Neurology, 'Attikon' University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece., Tsivgoulis G; Second Department of Neurology, 'Attikon' University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee, United States., Tsioufis C; First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: ktsioufis@hippocratio.gr.
Jazyk: angličtina
Zdroj: Pharmacological research [Pharmacol Res] 2022 Jan; Vol. 175, pp. 105902. Date of Electronic Publication: 2021 Sep 20.
DOI: 10.1016/j.phrs.2021.105902
Abstrakt: Background: In standard dosing, direct Oral Anticoagulants (DOACs) are used as an alternative to warfarin to prevent ischemic stroke and systemic embolism in non-valvular Atrial Fibrillation (AF). However, randomized comprehensive evidence considering the efficacy and safety of the low-dose DOACs in the same setting is still lacking. Toward this end, we conducted a meta-analysis of randomized trials to estimate the risk/benefit ratio, in terms of net clinical benefit, by comparing a reduced dose of DOACs and warfarin.
Methods: We searched three electronic databases, covering the period until end-February 2021. All-cause death, non-fatal stroke/systemic embolism, and major bleeding events, with or without the inclusion of myocardial infarction, were used to define two different net clinical benefit outcomes. In addition, we evaluated different component outcomes of net clinical benefit as secondary outcomes. Finally, risk ratios and 95% Confidence Intervals (CI) of each outcome were calculated (random-effects model).
Results: In the four randomized trials included (n = 29,779 patients), the net clinical benefit - with or without the inclusion of myocardial infarction - of low-dose DOACs, compared to warfarin, was a 12% (95% CI, 7%-16%) or a 10% (95% CI, 5%-13%) reduction of events, respectively. Compared to warfarin, the reduced dose of DOACs decreased death outcomes, major bleeding events, and hemorrhagic stroke, whereas all thrombotic outcomes were not different among the groups.
Conclusions: DOACs at low dosing present a more favorable net clinical benefit profile compared to warfarin.
(Copyright © 2021. Published by Elsevier Ltd.)
Databáze: MEDLINE
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