A Meta-Analysis on the Efficacy and Safety of New Oral Anticoagulants (NOACs) in the Management of Acute Myocardial Infarction (AMI)
DOI:
https://doi.org/10.52547/f6z4w649Keywords:
warfarin, NOACs, AMI,Abstract
In order to cope with the limitations of warfarin, a variety of new oral anticoagulants (NOACs) are being developed and approved for clinical use. As the aging population increases and
cardiovascular disease becomes younger, the use of NOACs as an alternative of traditional anticoagulant in patients with acute myocardial infarction (AMI) need to be discussed. A
systematic review and meta-analysis of controlled trials and high-quality cohort studies were used to compare the efficacy and safety of new oral anticoagulants with warfarin and
placebo trials in patients with AMI and related disease. Through a systematic search, 11
studies were included that compared the effectiveness of NOACs with warfarin by complete resolution of thrombus (OR, 1.58 95% CI 1.00, 2.50). In order to reflect the safety of NOACs, major bleeding (OR, 0.50 95% CI 0.16, 1.61) (OR, 3.20 95% CI 2.14, 4.81), stroke (OR, 0.77 95% CI 0.32, 1.90) (OR, 0.87 95% CI 0.63, 1.20), cardiovascular events (OR, 1.37 95% CI
0.73, 2.57) (OR, 0.94 95% CI 0.84, 1.07), and all-cause death (OR, 1.09 95% CI 0.42, 2.85)
(OR, 0.90 95% CI 0.79, 1.02) are compared by subgroup analysis (NOACs VS. Warfarin /
Placebo ). The results showed that NOACs had a higher risk of bleeding compared with
placebo. At the same time, no major statistical differences in efficacy and risk of negative
outcomes were found when comparing with warfarin. In conclusion, new oral anticoagulants are more suitable than traditional oral anticoagulants for AMI patients which need to take
long-term anticoagulant drugs because they do not require frequent blood monitoring. But at the same time, specific reversal agent for NOACs also need to be further discussed.
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