Mortality outcomes in patients receiving direct oral anticoagulants: A systematic review and meta-analysis of randomized controlled trials

© 2015 International Society on Thrombosis and Haemostasis. Background: Direct oral anticoagulants (DOACs) are widely used as an alternative for warfarin. However, the impact of DOACs on mortality outcomes compared with warfarin remains unclear. Objective: To estimate the mortality outcomes in patie...

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Main Authors: C. Chai-Adisaksopha, C. Hillis, T. Isayama, W. Lim, A. Iorio, M. Crowther
Format: Journal
Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/54800
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spelling th-cmuir.6653943832-548002018-09-04T10:23:47Z Mortality outcomes in patients receiving direct oral anticoagulants: A systematic review and meta-analysis of randomized controlled trials C. Chai-Adisaksopha C. Hillis T. Isayama W. Lim A. Iorio M. Crowther Medicine © 2015 International Society on Thrombosis and Haemostasis. Background: Direct oral anticoagulants (DOACs) are widely used as an alternative for warfarin. However, the impact of DOACs on mortality outcomes compared with warfarin remains unclear. Objective: To estimate the mortality outcomes in patients treated with DOACs vs. warfarin (or another vitamin K antagonist). Methods: MEDLINE, EMBASE and CENTRAL databases (inception to September 2014), conference abstracts and www.clinicaltrials.gov, were searched, without language restriction. Studies were selected if there were phase III, randomized trials comparing DOACs with warfarin in patients with non-valvular atrial fibrillation or venous thromboembolism. Results: Thirteen randomized controlled trials involving 102 707 adult patients were included in the analysis. The case-fatality rate of major bleeding was 7.57% (95% CI, 6.53-8.68; I2= 0%) in patients taking DOACs and 11.04% (95% CI, 9.16-13.07; I2= 33.3%) in patients taking warfarin. The rate of fatal bleeding in adult patients receiving DOACs was 0.16 per 100 patient-years (95% CI, 0.12-0.20; I2= 36.5%). When compared with warfarin, DOACs were associated with significant reductions in fatal bleeding (RR, 0.53; 95% CI, 0.43-0.64; I2= 0%), cardiovascular mortality (RR, 0.88; 95% CI, 0.82-0.94; I2= 0%) and all-cause mortality (RR, 0.91; 95% CI, 0.87-0.96; I2= 0%). Conclusions: The use of DOACs compared with warfarin is associated with a lower rate of fatal bleeding, case-fatality rate of major bleeding, cardiovascular mortality and all-cause mortality. 2018-09-04T10:23:47Z 2018-09-04T10:23:47Z 2015-01-01 Journal 15387836 15387933 2-s2.0-84946550723 10.1111/jth.13139 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84946550723&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/54800
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
C. Chai-Adisaksopha
C. Hillis
T. Isayama
W. Lim
A. Iorio
M. Crowther
Mortality outcomes in patients receiving direct oral anticoagulants: A systematic review and meta-analysis of randomized controlled trials
description © 2015 International Society on Thrombosis and Haemostasis. Background: Direct oral anticoagulants (DOACs) are widely used as an alternative for warfarin. However, the impact of DOACs on mortality outcomes compared with warfarin remains unclear. Objective: To estimate the mortality outcomes in patients treated with DOACs vs. warfarin (or another vitamin K antagonist). Methods: MEDLINE, EMBASE and CENTRAL databases (inception to September 2014), conference abstracts and www.clinicaltrials.gov, were searched, without language restriction. Studies were selected if there were phase III, randomized trials comparing DOACs with warfarin in patients with non-valvular atrial fibrillation or venous thromboembolism. Results: Thirteen randomized controlled trials involving 102 707 adult patients were included in the analysis. The case-fatality rate of major bleeding was 7.57% (95% CI, 6.53-8.68; I2= 0%) in patients taking DOACs and 11.04% (95% CI, 9.16-13.07; I2= 33.3%) in patients taking warfarin. The rate of fatal bleeding in adult patients receiving DOACs was 0.16 per 100 patient-years (95% CI, 0.12-0.20; I2= 36.5%). When compared with warfarin, DOACs were associated with significant reductions in fatal bleeding (RR, 0.53; 95% CI, 0.43-0.64; I2= 0%), cardiovascular mortality (RR, 0.88; 95% CI, 0.82-0.94; I2= 0%) and all-cause mortality (RR, 0.91; 95% CI, 0.87-0.96; I2= 0%). Conclusions: The use of DOACs compared with warfarin is associated with a lower rate of fatal bleeding, case-fatality rate of major bleeding, cardiovascular mortality and all-cause mortality.
format Journal
author C. Chai-Adisaksopha
C. Hillis
T. Isayama
W. Lim
A. Iorio
M. Crowther
author_facet C. Chai-Adisaksopha
C. Hillis
T. Isayama
W. Lim
A. Iorio
M. Crowther
author_sort C. Chai-Adisaksopha
title Mortality outcomes in patients receiving direct oral anticoagulants: A systematic review and meta-analysis of randomized controlled trials
title_short Mortality outcomes in patients receiving direct oral anticoagulants: A systematic review and meta-analysis of randomized controlled trials
title_full Mortality outcomes in patients receiving direct oral anticoagulants: A systematic review and meta-analysis of randomized controlled trials
title_fullStr Mortality outcomes in patients receiving direct oral anticoagulants: A systematic review and meta-analysis of randomized controlled trials
title_full_unstemmed Mortality outcomes in patients receiving direct oral anticoagulants: A systematic review and meta-analysis of randomized controlled trials
title_sort mortality outcomes in patients receiving direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84946550723&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/54800
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