Meta-analysis of the efficacy and safety of non-vitamin K antagonist oral anticoagulants with warfarin in Latin American patients with atrial fibrillation

Su, Zhiyu; Zhang, Hao; He, Wenfeng; Ma, Jianyong; Zeng, Junquan; Jiang, Xinhua

doi:10.1097/md.0000000000019542

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…In addition, we assessed crude event rates of outcomes between DOACs vs. warfarin in Latin/non-Latin American patients with AF. Overall, in comparison to warfarin, DOACs had lower or similar rates of thromboembolic and bleeding risk, which was consistent with a previous study (15). Interestingly, we found that DOACs increased the risk of myocardial infarction compared with warfarin in non-Latin American patients with AF.…”

Section: Discussionsupporting

confidence: 92%

“…Therefore, antithrombotic therapy is particularly important to reduce the risk of embolism in Latin American patients with AF. Previous meta-analyses including the posthoc analyses and sub-analyses of DOAC RCTs showed that there is a non-inferiority of DOACs compared with warfarin in Latin American patients with AF (15). Compared to the previous study, the RCTs included in this meta-analysis are outdated.…”

Section: Discussionmentioning

confidence: 94%

“…Although several new post-hoc analyses of randomized clinical trials (RCTs) well-examined the association between regions (Latin America vs. non-Latin America) and effectiveness and safety outcomes, even explored the use of individual DOACs compared with warfarin in Latin American patients, the superiority of DOACs therapy is still controversial. Although, a previous meta-analysis included the post-hoc analyses and sub-analyses of DOACs, RCTs identified a non-inferiority of DOACs compared with warfarin in Latin American patients with AF (15). However, the RCTs included in this meta-analysis are outdated.…”

Section: Introductionmentioning

confidence: 98%

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Direct Oral Anticoagulants vs. Warfarin in Latin American Patients With Atrial Fibrillation: Evidence From Four post-hoc Analyses of Randomized Clinical Trials

Liu

Wang

Luo

et al. 2022

Front. Cardiovasc. Med.

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BackgroundSeveral studies have investigated the effect of direct oral anticoagulants (DOACs) in Latin American patients with atrial fibrillation (AF), but the results remain controversial. Therefore, we aimed to compare the efficacy and safety of DOACs vs. warfarin in Latin American patients with AF.MethodsWe systematically searched the PubMed and Embase databases until November 2021 for studies that compared the effect of DOACs vs. warfarin in Latin patients with AF. Adjusted hazard ratios (HRs) and 95% CIs were pooled by a random-effects model using an inverse variance method.ResultsFour post-hoc analyses of randomized clinical trials (RCTs) involving 42,411 DOACs and 29,270 warfarin users were included. In Latin American patients with AF, for the effectiveness outcomes, the use of DOACs compared with warfarin was significantly associated with decreased risks of stroke or systemic embolism (SSE) (HR = 0.78; 95%CI.64–0.96), stroke (HR = 0.75; 95%CI.57–0.99), hemorrhagic stroke (HR = 0.14; 95%CI.05–0.36), all-cause death (HR = 0.89; 95% CI.80–1.00), but not ischemic stroke and cardiovascular death. For the safety outcomes, compared with warfarin, the use of DOACs was associated with reduced risks of major or non-major clinically relevant (NMCR) bleeding (HR = 0.70; 95% CI.57–0.86), major bleeding (HR = 0.70; 95%CI.53–0.92), intracranial hemorrhage (ICH) (HR = 0.42; 95%CI.24–0.74), or any bleeding (HR = 0.70;95% CI.62–0.78), but not gastrointestinal bleeding. In non-Latin American patients with AF, for the effectiveness outcomes, the use of DOACs compared with warfarin was significantly associated with decreased risks of SSE (HR = 0.87; 95%CI.75–1.00), hemorrhagic stroke (HR = 0.41; 95%CI.28–0.60), cardiovascular death (HR = 0.87; 95% CI.81–0.94), all-cause death (HR = 0.90; 95% CI.85–0.94). Conversely, the risk of myocardial infarction increased (HR = 1.34; 95% CI 1.13–1.60), but not ischemic stroke. For the safety outcomes, compared with warfarin, the use of DOACs was associated with reduced risks of major or NMCR bleeding (HR = 0.75; 95%CI.61–0.92), major bleeding (HR = 0.76; 95%CI.63–0.92), ICH (HR = 0.42; 95%CI.36–0.52), and any bleeding (HR = 0.81; 95% CI.71–0.92), but not gastrointestinal bleeding.ConclusionCurrent pooled data from the four post-hoc analyses of RCTs suggested that compared with warfarin, DOACs appeared to have significant reductions in SSE, stroke, hemorrhagic stroke, all-cause death, major or NMCR bleeding, major bleeding, ICH, and any bleeding, but comparable risks of ischemic stroke, cardiovascular death, and gastrointestinal bleeding in Latin American patients with AF. DOACs appeared to have significant reductions in SSE, hemorrhagic stroke, all-cause death, cardiovascular death, major or NMCR bleeding, major bleeding, ICH, and any bleeding, and increased the risk of myocardial infarction, but comparable risks of stroke, ischemic stroke, and gastrointestinal bleeding in non-Latin American patients with AF.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 98%

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Direct Oral Anticoagulants vs. Warfarin in Latin American Patients With Atrial Fibrillation: Evidence From Four post-hoc Analyses of Randomized Clinical Trials

Liu

Wang

Luo

et al. 2022

Front. Cardiovasc. Med.

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“…In this regard, however, there are cost-effectiveness studies that show that the absence of the need for serial controls of DOACs efficacy and the reduction in the number of hospitalizations for thrombotic or hemorrhagic events would reduce overall annual cost both for the patient and the health system in comparison with VKAs on long-term follow-up, in the treatment of patients with both acute PTE and other pathologies such as atrial fibrillation [29][30][31][32][33] .…”

Section: Discussionmentioning

confidence: 99%

Predictors of use of direct oral anticoagulants in acute pulmonary embolism

Barrionuevo¹,

Scatularo²,

Antoniolli³

et al. 2023

ACME

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Introduction:In the past decade, direct oral anticoagulants (DOACs) have been incorporated as an anticoagulation tool in patients with acute pulmonary thromboembolism (PTE). Although they have a better pharmacological profile than Vitamin K antagonists (VKAs), the use of these drugs is not massive. The objective of this study was to evaluate the use of DOACs in patients with acute PE and to detect determinants of its use. Methodology: An analysis of the CONAREC XX registry was performed to detect predictors of DOAC prescription at discharge in patients hospitalized with acute PE in 64 centers in Argentina. Results: A total of 579 patients who received anticoagulation at hospital discharge were analyzed: 60% received VKA, 21% heparin, and 19% DOAC (of them, 49% rivaroxaban, 34% apixaban, and 17% dabigatran). Patients receiving DOACs had less severe PE, lower risk of bleeding, and fewer in-hospital complications. At 30-day follow-up, there were no differences in all-cause mortality or bleeding. Health coverage by social insurance (OR = 7.45, p < 0.01) or by private coverage (OR = 10.5, CI = 95% 2.4-45.9, p < 0.01) was independent predictors of DOAC prescription at discharge, and history of heart failure (OR = 0.19, 95% CI = 0.04-0.84, p = 0.028) and oncological disease (OR = 0.49, 95% CI = 0.27-0.89; p = 0.02) were predictors not prescribe them. Conclusion: One in five survivors of acute PE received DOACs at hospital discharge in Argentina, and this was determined by clinical and economic variables.

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“…En el registro CONAREC XX 4 no se incorporó la estratificación de ingresos económicos de los pacientes, aunque bajo la hipótesis de que los sujetos con cobertura médica prepago tienen mayores ingresos que los pacientes con cobertura médica de seguridad social, y estos a su vez mayores ingresos que los que reciben atención en el sistema público, inferimos que el costo directo pagado por los pacientes y su cobertura médica influye en la decisión de la prescripción de estos fármacos. En relación con ello, sin embargo, existen estudios de costo-efectividad que demuestran que la ausencia de necesidad de controles seriados de la eficacia de los ACOD y la reducción en las internaciones por eventos trombóticos o hemorrágicos reducirían el costo global anual tanto para el paciente como para el sistema de salud en comparación con los AVK en el seguimiento a largo plazo, tanto en el tratamiento de pacientes con TEP aguda como con otras patologías como fibrilación auricular [29][30][31][32][33] .…”

Section: Discussionunclassified

Predictores de uso de anticoagulantes orales directos en tromboembolia pulmonar aguda

Barrionuevo¹,

Scatularo²,

Antoniolli³

et al. 2022

ACM

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Introducción: En la última década los anticoagulantes orales directos (ACOD) se incorporaron como herramienta para la anticoagulación en pacientes con tromboembolia pulmonar (TEP) aguda. Aunque tienen un mejor perfil farmacológico que los antagonistas de la vitamina K (AVK), el uso de estos fármacos no es masivo. El objetivo del presente trabajo fue evaluar el uso de ACOD en pacientes con TEP aguda y detectar determinantes de su indicación. Metodología: Análisis preespecificado del registro CONAREC XX que incorporó pacientes con TEP aguda en 64 centros de Argentina. Se realizó un análisis para detectar predictores de prescripción de ACOD al alta. Resultados: Se analizaron 579 pacientes que recibieron anticoagulación al alta hospitalaria: el 60% recibió AVK, el 21% heparinas y el 19% ACOD (de ellos, un 49% rivaroxabán, un 34% apixabán y un 17% dabigatrán). Los pacientes que recibieron ACOD tenían TEP de menor gravedad, menor riesgo de hemorragia y menos complicaciones intrahospitalarias. En el seguimiento a 30 días no hubo diferencias en mortalidad por todas las causas o sangrados. La cobertura de salud por un seguro social (odds ratio [OR]: 7.45; intervalo de confianza del 95% [IC 95%]: 1.74-31.9; p < 0.01) o por cobertura privada (OR: 10.5; IC 95%: 2.4-45.9; p < 0.01) fueron predictores independientes de la prescripción de ACOD al alta, y el antecedente de insuficiencia cardiaca (OR: 0.19; IC 95%: 0.04-0.84; p = 0.028) y de enfermedad oncológica (OR: 0.49; IC 95%: 0.27-0.89; p = 0.02) fueron predictores de no prescribirlos. Conclusiones: Uno de cada cinco supervivientes de TEP aguda recibió ACOD al egreso hospitalario en Argentina, y esto fue determinado por variables clínicas y económicas

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Meta-analysis of the efficacy and safety of non-vitamin K antagonist oral anticoagulants with warfarin in Latin American patients with atrial fibrillation

Abstract: Supplemental Digital Content is available in the text

Cited by 3 publications

References 31 publications

Direct Oral Anticoagulants vs. Warfarin in Latin American Patients With Atrial Fibrillation: Evidence From Four post-hoc Analyses of Randomized Clinical Trials

Direct Oral Anticoagulants vs. Warfarin in Latin American Patients With Atrial Fibrillation: Evidence From Four post-hoc Analyses of Randomized Clinical Trials

Predictors of use of direct oral anticoagulants in acute pulmonary embolism

Predictores de uso de anticoagulantes orales directos en tromboembolia pulmonar aguda

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