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The Risk of Gastrointestinal Bleeding between Non-Vitamin K Antagonist Oral Anticoagulants and Vitamin K Antagonists in the Asian Atrial Fibrillation Patients: A Meta-Analysis

1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
2
School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
3
Department of Chemistry, College of Science, National Kaohsiung Normal University, Kaohsiung 80201, Taiwan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2021, 18(1), 137; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010137
Received: 20 November 2020 / Revised: 11 December 2020 / Accepted: 23 December 2020 / Published: 27 December 2020
(This article belongs to the Special Issue Real-World Evidence in Clinical Epidemiology and Public Health)
Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are more commonly used to prevent atrial fibrillation (AF) patients from thromboembolic events than vitamin K antagonists (VKAs). However, the gastrointestinal bleeding (GIB) risk in the Asian AF patients associated with NOACs in comparison with VKAs remained unaddressed. Materials and Methods: A systematic search of studies on NOACs and VKAs in the Asian AF patients was conducted in PubMed, Cochrane Library, and ClinicalTrials.gov. The primary outcome was the hazard ratio (HR) of any GIB associated with NOACs versus VKAs. The secondary outcome was the GIB risks in different kinds of NOACs compared with VKAs. Results: This meta-analysis included two randomized controlled trials (RCTs) and four retrospective studies, comprising at least 200,000 patients in total. A significantly lower HR of GIB risks was found in all kinds of NOACs than VKAs in the Asian AF patients (HR: 0.633; 95% confidence interval: 0.535–0.748; p < 0.001). Additionally, the GIB risks of different NOACs were apixaban (HR: 0.392), edoxaban (HR: 0.603), dabigatran (HR: 0.685), and rivaroxaban (HR: 0.794), respectively. Conclusions: NOACs significantly reduced the risk of GIB in the Asian AF patients compared with VKAs. In the four NOACs compared with VKAs, apixaban probably had a trend of the least GIB risk. We need further head-to-head studies of different NOACs to confirm which NOAC is the most suitable for Asian AF patients and to know the optimal dosage regimen of different NOACs. View Full-Text
Keywords: gastrointestinal bleeding; Asian; atrial fibrillation; Non-vitamin K antagonist oral anticoagulants; vitamin K antagonists gastrointestinal bleeding; Asian; atrial fibrillation; Non-vitamin K antagonist oral anticoagulants; vitamin K antagonists
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MDPI and ACS Style

Yang, K.-T.; Sun, W.-C.; Tsai, T.-J.; Tsay, F.-W.; Chen, W.-C.; Cheng, J.-S. The Risk of Gastrointestinal Bleeding between Non-Vitamin K Antagonist Oral Anticoagulants and Vitamin K Antagonists in the Asian Atrial Fibrillation Patients: A Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 137. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010137

AMA Style

Yang K-T, Sun W-C, Tsai T-J, Tsay F-W, Chen W-C, Cheng J-S. The Risk of Gastrointestinal Bleeding between Non-Vitamin K Antagonist Oral Anticoagulants and Vitamin K Antagonists in the Asian Atrial Fibrillation Patients: A Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18(1):137. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010137

Chicago/Turabian Style

Yang, Kuang-Tsu, Wei-Chih Sun, Tzung-Jiun Tsai, Feng-Woei Tsay, Wen-Chi Chen, and Jin-Shiung Cheng. 2021. "The Risk of Gastrointestinal Bleeding between Non-Vitamin K Antagonist Oral Anticoagulants and Vitamin K Antagonists in the Asian Atrial Fibrillation Patients: A Meta-Analysis" International Journal of Environmental Research and Public Health 18, no. 1: 137. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010137

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