Comparative efficacy and safety of warfarin care bundles and novel oral anticoagulants in patients with atrial fibrillation: a systematic review and network meta-analysis

Autor:	Nowrozy Kamar Jahan, Siok Shen Ng, William Hollingworth, Khachen Kongpakwattana, Nathorn Chaiyakunapruk, Nai Ming Lai, Piyameth Dilokthornsakul, Surakit Nathisuwan
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	Male medicine.medical_specialty medicine.drug_class Pyridines Cardiology lcsh:Medicine Hemorrhage 030204 cardiovascular system & hematology Article law.invention Dabigatran 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Randomized controlled trial Edoxaban law medicine Humans 030212 general & internal medicine Intensive care medicine lcsh:Science Stroke Aged Randomized Controlled Trials as Topic Multidisciplinary business.industry Anticoagulant lcsh:R Warfarin Anticoagulants Atrial fibrillation Middle Aged medicine.disease Thiazoles Treatment Outcome chemistry Meta-analysis Female lcsh:Q business Patient Care Bundles medicine.drug
Zdroj:	Scientific Reports, Vol 10, Iss 1, Pp 1-11 (2020) Scientific Reports
ISSN:	2045-2322
DOI:	10.1038/s41598-019-57370-2
Popis:	Warfarin care bundles (e.g. genotype-guided warfarin dosing, patient’s self-testing [PST] or patient’s self-management [PSM] and left atrial appendage closure) are based on the concept of combining several interventions to improve anticoagulation care. NOACs are also introduced for stroke prevention in atrial fibrillation (SPAF). However, these interventions have not been compared in head-to-head trials yet. We did a network meta-analysis based on a systematic review of randomized controlled trials comparing anticoagulant interventions for SPAF. Studies comparing these interventions in adults, whether administered alone or as care bundles were included in the analyses. The primary efficacy outcome was stroke and the primary safety outcome was major bleeding. Thirty-seven studies, involving 100,142 patients were assessed. Compared to usual care, PSM significantly reduced the risk of stroke (risk ratio [RR] 0.24, 95% CI 0.08–0.68). For major bleeding, edoxaban 60 mg (0.80, 0.71–0.90), edoxaban 30 mg (0.48, 0.42–0.56), and dabigatran 110 mg (0.81, 0.71–0.94) significantly reduced the risk of major bleeding compared with usual warfarin care. Cluster rank plot incorporating stroke and major bleeding outcomes indicates that some warfarin care bundles perform as well as NOACs. Both interventions are therefore viable options to be considered for SPAF. Additional studies including head-to-head trials and cost-effectiveness evaluation are still warranted.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4fe8c20101d2f69cb38d1ec6fec18f1d http://link.springer.com/article/10.1038/s41598-019-57370-2 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.