Intraocular Bleeding in Patients With Atrial Fibrillation Treated With NOACs VS. Warfarin: A Systematic Review and Meta-Analysis

Abstract

BackgroundIntraocular bleeding is a devastating adverse event for patients with atrial fibrillation (AF) receiving anticoagulant therapy. It is unknown whether non-vitamin K oral anticoagulants (NOACs) compared with warfarin can reduce the risk of intraocular bleeding in patients with AF. Herein, we conducted a meta-analysis to evaluate the effect of NOACs vs. warfarin on intraocular bleeding in the AF population.MethodsStudies were systematically searched from the Embase, PubMed, and Cochrane databases until April 2022. We included studies if they enrolled patients with AF and compared the intraocular bleeding risk between NOACs and warfarin and if they were randomized controlled trials (RCTs) or observational cohort studies. The random-effects model was chosen to evaluate the pooled odds ratios (ORs) and 95% confidence intervals (CIs).ResultsA total of 193,980 patients with AF from 5 randomized controlled trials (RCTs) and 1 cohort study were included. The incidence of intraocular bleeding among AF patients treated with warfarin and NOACs was 0.87% (n = 501/57346) and 0.61% (n = 836/136634), respectively. In the pooled analysis with the random-effects model, the use of NOACs was not significantly associated with the risk of intraocular bleeding (OR = 0.74; 95% CI 0.52–1.04, P = 0.08) compared with warfarin use. In addition, the sensitivity analysis with the fixed-effects model suggested that NOAC users had a lower incidence of intraocular bleeding than patients with warfarin (OR = 0.57; 95% CI 0.51–0.63, P < 0.00001).ConclusionsOur current meta-analysis suggested that the use of NOACs had no increase in the incidence of intraocular bleeding compared with warfarin use in patients with AF. Whether the use of NOACs is superior to warfarin needs more research to confirm.

Complicaciones oculares derivadas del uso de nuevos anticoagulantes orales: revisión narrativa de la literatura

“…En el análisis agrupado con el modelo de efectos aleatorios, el uso de NOAC no se asoció significativamente con el riesgo de hemorragia intraocular (odds ratio [OR]: 0,74; IC95%: 0,52-1,04; p = 0,08) en comparación con el uso de warfarina. El análisis con el modelo de efectos fijos sugirió que los usuarios de NOAC tenían una menor incidencia de hemorragia intraocular que los pacientes con warfarina (OR: 0,57; IC95%: 0,51-0,63; p < 0,00001) 4 .…”