Efficacy and safety of non-vitamin K anticoagulants and warfarin in patients with atrial fibrillation and heart failure: A network meta-analysis

Jin, Hao; Zhu, Kongbo; Wang, Lina; Zhou, Wangjuan; Huang, Zhi

doi:10.1016/j.thromres.2020.08.021

Cited by 6 publications

(4 citation statements)

References 28 publications

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“… 24–26 A recent meta-analysis focusing on RCTs comparing the effect of NOACs with warfarin in patients with AF and HF showed that NOACs have become the preferred choice for preventing stroke/SEE and major bleeding in AF patients with HF. 30 Annualized event rates in our analyses, though low, were almost twice as high for major bleeding in patients with vs. without HF and comparable across HF subgroups. We confirmed the moderate predictive ability of the variables comprised in the HAS-BLED score for bleeding.…”

Section: Discussionmentioning

confidence: 52%

Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry

Schnabel,

Ameri,

Siller-Matula

et al. 2023

Europace

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Background and Aims Heart failure (HF) is a risk factor for major adverse events in atrial fibrillation (AF). Whether this risk persists on non-vitamin K oral anticoagulants (NOACs) and varies according to left ventricular ejection fraction (LVEF) is debated. Methods We investigated the relation of HF in the ETNA-AF-Europe registry, a prospective, multi-centre, observational study with an overall 4-year follow-up of edoxaban-treated AF patients. We report 2-year follow-up for ischaemic stroke/transient ischaemic attack (TIA)/systemic embolic events (SEE), major bleeding, and mortality. Results Of the 13,133 patients, 1,854 (14.1%) had HF. LVEF was available for 82.4% of HF patients and was <40% in 671 (43.9%) and ≥40% in 857 (56.1%). Patients with HF were older, more often men and had more comorbidities. Annualised event rates (AnERs) of any stroke/SEE were 0.86%/year and 0.67%/year in patients with and without HF. Compared with patients without HF, those with HF also had higher AnERs for major bleeding (1.73%/year versus 0.86%/year) and all-cause death (8.30%/year versus 3.17%/year). Multivariate Cox proportional models confirmed HF as a significant predictor of major bleeding (hazard ratio [HR] 1.65, 95% confidence interval [CI]:1.20–2.26) and all-cause death (HF with LVEF <40% [HR 2.42, 95%CI:1.95–3.00] and HF with LVEF ≥40% [HR 1.80, 95%CI:1.45–2.23]), but not of ischaemic stroke/TIA/SEE. Conclusions Anticoagulated patients with HF at baseline featured higher rates of major bleeding and all-cause death, requiring optimised management and novel preventive strategies. NOAC treatment was similarly effective in reducing risk of ischaemic events in patients with or without concomitant HF.

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Section: Discussionmentioning

confidence: 52%

Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry

Schnabel,

Ameri,

Siller-Matula

et al. 2023

Europace

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“…У больных с ФП и ХСН при назначении АКТ необходимо учитывать не только риск возможных кровотечений, но и соотношение эффективность/безопасность препарата. Так, в метаанализе, сравнившем 4 ПОАК у пациентов с ХСН, подтвердилась исходно ожидаемая более высокая эффективность дабигатрана в дозе 150 мг 2 раза в день (площадь под кривой распределения -SUCRA 0,82) и апиксабана (SUCRA 0,81), далее со значительно менее убедительными показателями следовали эдоксабан в дозе 60 мг 2 раза в день (SUCRA 0,57) и ривароксабан (SUCRA 0,52) [42]. Однако с точки зрения безопасности для предотвращения крупного кровотечения эдоксабан в сниженной дозе 30 мг 2 раза в день (SUCRA 0,99) оказался самым безопасным препаратом, далее наиболее безопасным признан апиксабан в обычной дозе (SUCRA 0,71), затем эдоксабан в дозе 60 мг 2 раза в день (SUCRA 0,59) и дабигатран 150 мг 2 раза в день (SUCRA 0,55).…”

Section: антикоагулянтная терапия у пациентов с фп и снunclassified

“…Однако с точки зрения безопасности для предотвращения крупного кровотечения эдоксабан в сниженной дозе 30 мг 2 раза в день (SUCRA 0,99) оказался самым безопасным препаратом, далее наиболее безопасным признан апиксабан в обычной дозе (SUCRA 0,71), затем эдоксабан в дозе 60 мг 2 раза в день (SUCRA 0,59) и дабигатран 150 мг 2 раза в день (SUCRA 0,55). В заключение данной работы авторами предлагается следующая последовательность выбора ПОАК для предотвращения инсульта, системной эмболии и крупных кровотечений у пациентов с ФП и ХСН: апиксабан, эдоксабан -60 мг 2 раза в день и дабигатран -150 мг 2 раза в день [42].…”

Section: антикоагулянтная терапия у пациентов с фп и снunclassified

Treatment strategies for patients with atrial fibrillation and chronic heart failure

Tereshchenko

Uskach

2021

Terapevticheskii arkhiv

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Atrial fibrillation (AF) is associated with significant morbidity and mortality and may lead to the development of chronic heart failure (CHF). Each condition predisposes to the other, requiring a careful choice of the treatment strategy. This article is devoted to the prevalence and prognostic implications of both diseases. The article presents data from meta-analyzes related to the management of this group of patients. The aspects of rhythm control strategy in AF and concomitant CHF are described according to the recent studies and clinical guidelines. The features of anticoagulant therapy in patients with AF and CHF are outlined. Much attention is given to the importance of the safety profile of the anticoagulant therapy in terms of the bleeding risk in patients with concomitant AF and CHF.

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“…Moreover, it also eliminates the need of long-term testing. Early studies have shown that it is as effective and safe as warfarin [11][12][13][14]. Therefore, it is particularly important to determine the accuracy of the RCTs of NOACs for AF.…”

Section: Introductionmentioning

confidence: 99%

Reporting Quality of Randomized Controlled Trials Evaluating Non- Vitamin K Oral Anticoagulants in Atrial Fibrillation：A systematic review

Yang

Han

Zou

et al. 2023

Preprint

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Background: Randomized controlled trials (RCTs) are subject to bias if they lack methodological quality. Furthermore, optimal and transparent reporting of RCT ﬁndings aids their critical appraisal and interpretation. This study aimed to comprehensively evaluate the report quality of RCTs of non-vitamin K oral anticoagulants (NOACs) for the treatment of atrial fibrillation (AF) and to analyze the factors influencing the quality. Methods: By searching PubMed, Embase, Web of Science, and Cochrane Library databases RCTs published from inception to 2022 evaluating the efficacy of NOACs on AF were collected. By using the 2010 Consolidated Standards for Reporting Tests (CONSORT) statement, the overall quality of each report was assessed. Results: Sixty-twoRCTs were retrieved in this study. The median of overall quality score in 2010 was 14 (range: 8.5-20). The extent of compliance with the Consolidated Standards of Reporting Trials reporting guideline differed substantially across items: 9 items were reported adequately (more than 90%), and 3 were reported adequately in less than 10% of trials. Multivariate linear regression analysis showed that the higher reporting scores were associated with higher journal impact factor (P = 0.02), international collaboration (P < 0.01), and Sources of trial funding (P = 0.04). Conclusions: Although a large number of randomized controlled trials of NOACs for the treatment of AFwere published after the CONTORT statement in 2010, the overall quality is still not satisfactory, thus weakening their potential utility and may mislead clinical decisions. This survey provides the first hint for researchers conducting trials of NOACs for AF to improve the quality of reports and to actively apply the CONSORT statement.

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Efficacy and safety of non-vitamin K anticoagulants and warfarin in patients with atrial fibrillation and heart failure: A network meta-analysis

Cited by 6 publications

References 28 publications

Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry

Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry

Treatment strategies for patients with atrial fibrillation and chronic heart failure

Reporting Quality of Randomized Controlled Trials Evaluating Non- Vitamin K Oral Anticoagulants in Atrial Fibrillation：A systematic review

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