Background: Prior studies have suggested that NOACs have a favorable risk-benefit profile when compared with warfarin, but it is unclear if this advantage also is present for those high-risk patients for whom NOAC dose reduction is recommended.
Study design: A meta-analysis.
Setting: Three phase 3 randomized, control trials.
Synopsis: From the three randomized, control trials, the authors identified 7,351 of the 46,426 patients as being eligible for dose-reduced NOACs. Of these patients, 3,702 were randomized to take a NOAC and 3,649 were randomized to take warfarin. For the primary outcomes of stroke or systemic embolism, there was no significant difference between patients randomized to receive dose-reduced NOAC versus warfarin. For outcomes of major bleeding, hemorrhagic stroke, intracranial hemorrhage, and fatal bleeding, dose-reduced NOACs had a significantly lower risk, compared with warfarin.
Bottom line: In patients eligible for dose-reduced NOACs, the use of dose-reduced NOACs may have a better safety profile without significant difference in the rate of ischemic stroke or systemic embolism.
Citation: Wang KL et al. Efficacy and safety of reduced-dose non–vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: A meta-analysis of randomized controlled trials. Eur Heart J. 2018 Dec 22. doi: 10.1093/eurheartj/ehy802.
Dr. Biddick is a hospitalist at Beth Israel Deaconess Medical Center and instructor in medicine Harvard Medical School.