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Thromb Haemost 2025; 125(02): 166-177
DOI: 10.1055/s-0043-1770724
Stroke, Systemic or Venous Thromboembolism

Effect of Oral Anticoagulants in Atrial Fibrillation Patients with Polypharmacy: A Meta-analysis

Yuxiang Zheng    *
1   Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Siyuan Li   *
2   Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Xiao Liu   *
3   Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
,
Gregory Y. H. Lip    **
4   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
5   Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
Linjuan Guo
6   Department of Cardiology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang of Jiangxi, China
,
Wengen Zhu
7   Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
› Author Affiliations
Funding This study was supported by the National Natural Science Foundation of China (82100273) and Guangdong Natural Science Foundation (2023A1515012798).
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Abstract

Background The aim of the present meta-analysis was to evaluate the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients with polypharmacy.

Methods and Results Randomized controlled trials or observational studies reporting the data of NOACs versus VKAs 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 767,544 AF patients were included. For the primary outcomes, the use of NOACs compared with VKAs was significantly associated with a reduced risk of stroke or systemic embolism in AF patients with moderate polypharmacy (hazard ratio [HR]: 0.77 [95% confidence interval [CI]: 0.69–0.86]) and severe polypharmacy (HR: 0.76 [95% CI: 0.69–0.82]), but 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 between the NOAC- and VKA- users, but NOAC users had a reduced risk of any bleeding compared with VKA- users. Compared with VKAs, the risk of intracranial hemorrhage was reduced in NOAC- users with moderate polypharmacy but not severe polypharmacy.

Conclusion In patients with AF and polypharmacy, NOACs showed advantages over VKAs in stroke or systemic embolism and any bleeding, and were comparable to VKAs for major bleeding, ischemic stroke, all-cause death, intracranial hemorrhage, and gastrointestinal bleeding.

Keywords

atrial fibrillation - non-vitamin K antagonist oral anticoagulants - vitamin K antagonists - polypharmacy - meta-analysis

Authors' Contribution

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


* Co-first authors.


** Senior author.


The review process for this paper was fully handled by Christian Weber, Editor in Chief.


Supplementary Material



Publication History

Received: 28 January 2023

Accepted: 22 May 2023

Article published online:
03 July 2023

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