BACKGROUND

Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation (AF) originated from western countries.

AIM

To systematically review and quantitatively synthesize the real-world data regarding the efficacy and safety of dabigatran, rivaroxaban, and apixaban compared to warfarin for stroke prevention in Asian patients with non-valvular AF.

METHODS

Medline, Cochrane, and ClinicalTrial. gov databases were reviewed. A random-effect model meta-analysis was used and I-square was utilized to assess the heterogeneity. The primary outcome was ischemic stroke. The secondary outcomes were all-cause mortality, major bleeding, intracranial hemorrhage, and gastrointestinal bleeding.

RESULTS

Twelve studies from East Asia or Southeast Asia and 441450 patients were included. Dabigatran, rivaroxaban, and apixaban were associated with a significant reduction in the incidence of ischemic stroke [hazard ratio (HR)= 0.78, 95% confidence interval (CI): 0.65-0.94; HR= 0.79, 95% CI: 0.74-0.85, HR= 0.70, 95% CI: 0.62-0.78; respectively], all-cause mortality (HR= 0.68, 95% CI: 0.56-0.83; HR= 0.66, 95% CI: 0.52-0.84; HR= 0.66, 95% CI: 0.49-0.90; respectively), and major bleeding (HR= 0.61, 95% CI: 0.54-0.69; HR= 0.70, 95% CI: 0.54-0.90; HR= 0.58, 95% CI: 0.43-0.78; respectively) compared to warfarin.

CONCLUSION

Dabigatran, rivaroxaban, and apixaban appear to be superior to warfarin in both efficacy and safety in Asians with non-valvular AF.