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dc.contributor.authorLiew, A.
dc.contributor.authorO'Donnell, M.
dc.contributor.authorDouketis, J.
dc.date.accessioned2018-09-20T16:14:35Z
dc.date.available2018-09-20T16:14:35Z
dc.date.issued2014-07-25
dc.identifier.citationLiew, A. O'Donnell, M.; Douketis, J. (2014). Comparing mortality in patients with atrial fibrillation who are receiving a direct-acting oral anticoagulant or warfarin: a meta-analysis of randomized trials. Journal of Thrombosis and Haemostasis 12 (9), 1419-1424
dc.identifier.issn1538-7933
dc.identifier.urihttp://hdl.handle.net/10379/12453
dc.description.abstractBackgroundIn patients with non-valvular atrial fibrillation (AF), direct-acting oral anticoagulants (DOACs) are at least non-inferior to warfarin for the prevention of stroke and systemic embolism. The main objective of this study was to obtain reliable and precise estimates for all-cause mortality, vascular mortality and bleeding mortality in patients with AF receiving a DOAC or warfarin for stroke prevention. MethodsA meta-analysis was performed on phase3 randomized trials that compared a DOAC with warfarin for stroke prevention in AF. Published data were pooled by use of the DerSimonian random-effect model, with revman5.2 and comprehensive meta analysis software version2. The results were presented as risk ratios (RRs), absolute risk reduction (ARR), and number-needed-to-treat (NNT). ResultsA total of 71683 patients were included in this meta-analysis from four randomized controlled trials (median patient follow-up: 1.8-2.8years) that compared a DOAC with warfarin for stroke prevention in AF. As compared with warfarin, DOACs significantly reduced all-cause mortality (RR0.89, 95% confidence interval [CI]0.85-0.94; ARR0.76%, 95%CI0.39-1.13%; NNT=132), vascular mortality (RR0.88, 95%CI0.82-0.94; ARR0.53%, 95%CI0.23-0.83%; NNT=189), and bleeding mortality (RR0.54, 95%CI0.44-0.67; ARR0.32%, 95%CI0.21-0.43%; NNT=313). ConclusionAs compared with warfarin therapy for stroke prevention in patients with AF, DOACs significantly reduce all-cause mortality, vascular mortality, and bleeding mortality. This mortality benefit appears to be driven by the reduction in vascular-related and bleeding-related mortality, which, in turn, may be related to the reduction in intracranial bleeding.
dc.publisherWiley-Blackwell
dc.relation.ispartofJournal of Thrombosis and Haemostasis
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 Ireland
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/3.0/ie/
dc.subjectanticoagulants
dc.subjectatrial fibrillation
dc.subjecthemorrhage
dc.subjectmortality
dc.subjectwarfarin
dc.subjectre-ly trial
dc.subjectvenous thromboembolism
dc.subjectheart-association
dc.subjectdabigatran
dc.subjectguidelines
dc.subjecttherapy
dc.subjectstroke
dc.subjectprevention
dc.subjectmanagement
dc.subjectupdate
dc.titleComparing mortality in patients with atrial fibrillation who are receiving a direct-acting oral anticoagulant or warfarin: a meta-analysis of randomized trials
dc.typeArticle
dc.identifier.doi10.1111/jth.12651
dc.local.publishedsourcehttp://onlinelibrary.wiley.com/doi/10.1111/jth.12651/pdf
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