Association between polypharmacy and outcomes in AF patients
We synthesized the results of the included 3 post-hoc analyses RCTs [9, 10, 28] and 2 observational studies [8, 30] reporting outcomes in AF patients receiving oral anticoagulation with and without polypharmacy.
As shown in Figure 2 and Supplementary Figure Ⅰ , there were no differences in the rates of SSE between moderate polypharmacy (HR, 1.07 [95% CI, 0.95–1.21]) and severe polypharmacy (HR, 1.14 [95% CI, 0.89–1.47]) versus no-polypharmacy patients. Moderate polypharmacy was associated with an increased risk of all-cause death (HR, 1.34 [95% CI, 1.25–1.44]) and major bleeding (HR, 1.23 [95% CI, 1.10–1.37]) compared with no-polypharmacy AF patients. Risk of all-cause death (HR, 1.66 [95% CI, 1.29–2.31]) and major bleeding (HR, 1.56 [95% CI, 1.25–1.93]) were significantly increased in severe polypharmacy patients. In addition, the risk of intracranial hemorrhage was not statistically different in moderate polypharmacy (HR, 1.17 [95% CI, 0.81–1.70]), but was increased in severe polypharmacy (HR, 1.27 [95% CI, 1.02–1.58]), compared with non-polypharmacy patients.
Effect of NOACs versus VKAsin patients with AF and polypharmacy