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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Dabigatran, rivaroxaban, and apixaban are superior to warfarin in Asian patients with non-valvular atrial fibrillation: An updated meta-analysis
Wei-Jia Li, Paraschos Archontakis-Barakakis, Leonidas Palaiodimos, Dimitrios Kalaitzoglou, Lazaros Tzelves, Apostolos Manolopoulos, Yu-Chiang Wang, Stefanos Giannopoulos, Robert Faillace, Damianos G Kokkinidis
Wei-Jia Li, Paraschos Archontakis-Barakakis, Leonidas Palaiodimos, Yu-Chiang Wang, Robert Faillace, Damianos G Kokkinidis, Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, United States
Dimitrios Kalaitzoglou, Department of Surgery, 424 General Army Hospital of Thessaloniki, Thessaloniki 56429, Greece
Lazaros Tzelves, Department of Urology, Sismanogleio Hospital, Athens 15126, Greece
Apostolos Manolopoulos, Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
Stefanos Giannopoulos, Division of Cardiology, Rocky Mountain Regional VA Medical Center, Denver, CO 80045, United States
Author contributions: All listed authors have: (1) Substantial contributions to the conception and design or the acquisition, analysis, or interpretation of the data; (2) Substantial contributions to the drafting of the articles or critical revision for important intellectual content; (3) Final approval of the version to be published; and (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved.
Conflict-of-interest statement: All the authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Damianos G Kokkinidis, MD, MSc, Academic Fellow, Doctor, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461, United States. damiankokki@gmail.com
Received: December 8, 2020
Peer-review started: December 8, 2020
First decision: February 15, 2021
Revised: February 21, 2021
Accepted: April 13, 2021
Article in press: April 13, 2021
Published online: April 26, 2021
ARTICLE HIGHLIGHTS
Research background
Stroke is the second leading cause of mortality and disability worldwide with one-third of all ischemic stroke cases attributed to atrial fibrillation (AF).
Research motivation
Warfarin was the standard of care of stroke prevention in patients with nonvalvular AF but novel oral anticoagulants including dabigatran, rivaroxaban, and apixaban have demonstrated better efficacy and safety than warfarin in randomized clinical trials but they originated from Western countries where the Asian population was underrepresented.
Research objectives
We aimed to systematically review and quantitatively analyze the existing real-world observational studies regarding the efficacy and safety of dabigatran, rivaroxaban, and apixaban when they are compared with warfarin for stroke prevention in Asian patients with non-valvular AF.
Research methods
The study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Cochrane, and ClinicalTrial.gov databases were systematically searched. A random-effect model meta-analysis was used and I2 was utilized to assess heterogeneity. Risk of bias assessment was performed for every study included.
Research results
Twelve studies were qualified for our study. Dabigatran, rivaroxaban, and apixaban were all associated with significantly reduced incidence of ischemic stroke, all-cause mortality, major bleeding, and gastrointestinal bleeding. Dabigatran was also found associated with a lower risk of intracranial hemorrhage.
Research conclusions
Dabigatran, rivaroxaban, and apixaban have better efficacy and safety profile than warfarin for stroke prevention in Asian patients with non-valvular AF.
Research perspectives
Future research which conducts a head-to-head comparison between different novel oral anticoagulants is necessary to determine the best option for Asian patients with non-valvular AF.
