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Evidence summaries

Noac Versus Warfarin Postpci in Atrial Fibrillation

NOACs may reduce the rates of bleeding compared with warfarin following percutaneous coronary interventions (PCI) in people with indication for oral anticoagulation due to non-valvular atrial fibrillation. Level of evidence: "C"

The quality of evidence is downgraded by inconsistency (variability in results) and by imprecise results (wide confidence intervals).

Summary

A Cochrane review and network meta-analysis [Abstract] 1 included 5 studies with a total of 8 373 subjects with non-valvular atrial fibrillation with an indication for anticoagulation who underwent percutaneous coronary intervention (PCI). Studies comparing non-vitamin K antagonist oral anticoaculants (NOAC) with placebo, vitamin K antagonists, or a different type of NOAC were included.Co-interventions with single or dual antiplatelet therapy were included, even if they were part of the randomised treatment. Two studies compared apixaban to warfarin, 2 compared rivaroxaban to warfarin, and 1 study compared dabigatran to warfarin.

There was little or no difference between NOACs and warfarin in death from cardiovascular causes, myocardial infarction, stroke, death from any cause, and stent thrombosis. Apixaban and rivaroxaban reduced the risk of recurrent hospitalisation compared with warfarin.Dabigatran reduced both major and non-major bleeding, and other NOACs (apixaban and rivaroxaban) reduced non-major bleeding compared to warfarin. There was no significant differences between NOACs in the network meta-analysis.

Comments

Using NOAC in combination with antiplatelet therapy might be safer than triple therapy regimen of warfarin plus dual antiplatelet therapy following percutaneous coronary intervention (PCI) in people with an indication for oral anticoagulation due to non-valvular atrial fibrillation. Low-certainty evidence suggests little or no difference between NOACs and warfarin regarding efficacy outcomes.

Note

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    References

    • Al Said S, Alabed S, Kaier K et al. Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis. Cochrane Database Syst Rev 2019;(12):CD013252. [PubMed]

Primary/Secondary Keywords