Efficacy and safety of new oral anticoagulants for the treatment of patients over 70 years with atrial fibrillation: A meta-analysis
10.3760/cma.j.issn.0254-9026.2022.01.019
- VernacularTitle:新型口服抗凝药治疗70岁以上老年心房颤动患者疗效及安全性的Meta分析
- Author:
Jiashun HUANG
1
;
Jihong YANG
;
Hui WANG
;
Ying LIU
Author Information
1. 中国医学科学院北京协和医学院研究生院 100730
- Keywords:
New oral anticoagulants;
Warfarin;
Atrial fibrillation;
Meta-analysis
- From:
Chinese Journal of Geriatrics
2022;41(1):89-94
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically review the efficacy and safety of new oral anticoagulants(NOACs)for the treatment of patients over 70 years with atrial fibrillation.Methods:Studies comparing NOACs(dabigatran, rivaroxaban, apixaban, ximelagatran and edoxaban)versus warfarin for the treatment of patients over 70 years with atrial fibrillation were searched through databases including PubMed, Embase and the Cochrane Library, from the earliest electronic records to those published in March 2021.Stata15.0 software was used for meta-analysis.Results:A total of 19 studies and 215 471 patients were included.Meta-analysis results showed that, compared with warfarin, either a low-dose(110 mg)or a standard-dose(150 mg)of dabigatran reduced the risk of stroke/systemic embolism(SSE)in patients over 70 years with atrial fibrillation.A standard-dose of dabigatran did not decrease the risk of major bleeding, but a low dose was able to achieve it.A standard-dose(20 mg)of rivaroxaban could considerably reduce the risk of SSE in geriatric patients over 70 years with atrial fibrillation without increasing the risk of major bleeding.A standard-dose(5 mg)of apixaban could considerably decrease the risk of SSE and major bleeding in patients over 70 years with atrial fibrillation; A standard-dose(36 mg)of ximelagatran was as effective as warfarin in decreasing the incidence of SSE in patients over 70 years with atrial fibrillation, but could also considerably decrease the risk of major bleeding; A low-dose(15-30 mg)or a standard-dose(30-60 mg)of edoxaban decreased the incidence of SSE in patients over 70 years with atrial fibrillation, as did warfarin, but edoxaban considerably decreased the risk of major bleeding.Conclusions:Compared with warfarin, most of new oral anticoagulants show good efficacy in patients over 70 years old with atrial fibrillation, NOACs given at standard doses increase the risk of major bleeding, but at low doses can realize both efficacy and safety.
