Effect of oral anticoagulants in atrial fibrillation patients with
polypharmacy: a meta-analysis
Abstract
Aims: The aim of the present meta-analysis was to evaluate the
effectiveness and safety of non–vitamin K antagonist oral
anticoagulants (NOACs) vs. vitamin K antagonists (VKAs) in atrial
fibrillation (AF) patients with polypharmacy. Methods and results:
Randomized controlled trials or observational studies reporting the data
about the NOACs and VKAs therapy among AF patients with polypharmacy
were included. The search was performed in the PubMed and Embase
databases up to November 2022. There were no differences in the rates of
SSE but increased risk of all-cause death and major bleeding between
moderate polypharmacy and severe polypharmacy versus no-polypharmacy
patients. The use of NOACs compared with VKAs was significantly
associated with reduced risks of stroke or systemic embolism (SSE) in AF
patients with moderate polypharmacy (hazard ratios [HRs], 0.77
[95% confidence intervals [CIs], 0.69–0.86]) and severe
polypharmacy (HR, 0.76 [95% CI, 0.69–0.82]) and there was no
significant difference in major bleeding (moderate polypharmacy: HR,
0.87 [95% CI, 0.74–1.01]; severe polypharmacy: HR, 0.91 [95%
CI, 0.79–1.06]) between the two groups. There were no differences in
the rates of ischemic stroke, all-cause death, and gastrointestinal
bleeding but reduced risk of any bleeding between the NOACs and VKAs
users. Compared with VKAs, the risk of intracranial hemorrhage was
reduced in patients with moderate polypharmacy but not in patients with
severe polypharmacy in NOACs users. Conclusion: In patients with AF and
polypharmacy, NOACs showed advantages over VKAs in SSE and bleeding, and
non-inferiority in major bleeding, ischemic stroke, all-cause death,
intracranial hemorrhage, and gastrointestinal bleeding.