Factor Xa inhibitors versus warfarin in patients with non-valvular atrial fibrillation and diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials
Patients with non-valvular atrial fibrillation with diabetes face increased stroke and cardiovascular risks. This study compares factor Xa inhibitors and warfarin using data from randomized controlled trials (RCTs). MEDLINE, Embase, and Cochrane CENTRAL databases were searched for RCTs comparing the...
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| Published in: | Annals of medicine and surgery Vol. 86; no. 2; pp. 986 - 993 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Lippincott Williams & Wilkins
01-02-2024
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Patients with non-valvular atrial fibrillation with diabetes face increased stroke and cardiovascular risks. This study compares factor Xa inhibitors and warfarin using data from randomized controlled trials (RCTs).
MEDLINE, Embase, and Cochrane CENTRAL databases were searched for RCTs comparing the risk of efficacy and safety of any factor Xa inhibitors with dose-adjusted warfarin by diabetes status. Incidence of stroke/systemic embolism, major bleeding, intracranial hemorrhage, ischemic stroke, all-cause mortality, risk of hemorrhagic stroke, and myocardial infarction were among the outcomes of interest. A generic inverse-weighted random-effects model was used to calculate hazard ratios (HRs) with 95 percent confidence intervals (CIs).
After applying exclusion criteria, four RCTs containing 19 818 patients were included in the analysis. Compared with warfarin, meta-analysis showed statistically significant reduction in incidence of stroke/systemic embolism (HR 0.80 [95% CI 0.69-0.92];
=0.002), intracranial hemorrhage (HR 0.49 [95% CI 0.37-0.65];
<0.001), and risk of hemorrhagic stroke (HR 0.37 [95% CI 0.20-0.66];
=0.001) in patients on factor Xa inhibitors. However, there was no discernible difference between two treatment arms in incidence of major bleeding (HR 0.93 [95% CI 0.84-1.04];
=0.19), ischemic stroke (risk ratio (RR) 0.90 [95% CI 0.73-1.12;
=0.34), myocardial infarction (RR 0.88 [95% CI 0.67-1.15];
=0.35), and all-cause mortality (RR 0.89 [95% CI 0.79-1.01];
=0.06).
Factor Xa inhibitors show a favorable balance between efficacy and safety compared with warfarin, which is consistent across a wide range of patients with atrial fibrillation known to be at high risk for both ischemic and bleeding events. |
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| Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
| ISSN: | 2049-0801 2049-0801 |
| DOI: | 10.1097/MS9.0000000000001621 |