Background:
Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF) originated from western countries. We aimed to systematically review and quantitatively synthesize the real-world data regarding the efficacy and safety of dabigatran, rivaroxaban, and apixaban compared to warfarin for stroke prevention in Asian patients with non-valvular AF.
Methods:
Medline and Cochrane databases were reviewed. A random-effect model meta-analysis was used and I-square was utilized to assess the heterogeneity. The primary outcome was ischemic stroke. The secondary outcomes were all-cause mortality, major bleeding, intracranial hemorrhage, and gastrointestinal bleeding.
Results:
Twelve studies from East Asia or Southeast Asia and 429496 patients in total were included. Dabigatran, rivaroxaban, and apixaban were associated with a significant reduction in the incidence of ischemic stroke (HR=0.78, 95% CI, 0.65-0.94; HR=0.79, 95% CI, 0.74-0.85, HR=0.70, 95% CI, 0.62-0.78; respectively), all-cause mortality (HR=0.68, 95% CI, 0.56-0.83; HR=0.66, 95% CI, 0.52-0.84; HR=0.66, 95% CI, 0.49-0.90; respectively), and major bleeding (HR=0.61, 95%CI, 0.54-0.69; HR=0.70, 95% CI, 0.54-0.90; HR=0.58, 95% CI, 0.43-0.78; respectively) compared to warfarin.
Conclusion:
Dabigatran, rivaroxaban, and apixaban appear to be superior to warfarin in both efficacy and safety in Asian patients with non-valvular AF.
The CHADS2 and CHA2DS2-VASc scores for predicting ischemic stroke among East Asian patients with atrial fibrillation: A systemic review and meta-analysis