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Title: Comparative efficacy and safety of warfarin care bundles and novel oral anticoagulants in patients with atrial fibrillation: a systematic review and network meta-analysis
Authors: Siok Shen Ng
Nai Ming Lai
Surakit Nathisuwan
Nowrozy Kamar Jahan
Piyameth Dilokthornsakul
Khachen Kongpakwattana
William Hollingworth
Nathorn Chaiyakunapruk
Taylor's University Malaysia
University of Utah
Naresuan University
Monash University Malaysia
University of Bristol, Faculty of Medicine and Dentistry
Mahidol University
Hospital Melaka
Keywords: Multidisciplinary
Issue Date: 1-Dec-2020
Citation: Scientific Reports. Vol.10, No.1 (2020)
Abstract: © 2020, The Author(s). 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.
ISSN: 20452322
Appears in Collections:Scopus 2020

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