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. A
total of 12 studies involving 767,093 AF patients were included. 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. For the primary outcomes,
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. In secondary outcomes, 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.
Keywords: Atrial fibrillation; non-vitamin K oral antagonists;
vitamin K antagonists; polypharmacy; meta-analysis.