Effect of non-vitamin K antagonist oral anticoagulants versus warfarin in heart failure patients with atrial fibrillation

Several studies have investigated the efficacy and safety outcomes of non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients with atrial fibrillation (AF) and heart failure (HF). Herein, this meta-analysis was aimed to compare the effect of NOACs with warfarin in this population. We systematically searched the PubMed database until December 2019 for studies that compared the effect of NOACs with warfarin in patients with AF and HF. Risk ratios (RRs) and 95% confidence intervals (CIs) were abstracted and then pooled using a random-effects model. A total of nine studies were included in this meta-analysis. Compared with warfarin use, the use of NOACs was significantly associated with reduced risks of stroke or systemic embolism (RR = 0.82 (95% CI, 0.73-0.92)), all-cause death (RR = 0.87 (95% CI, 0.80-0.94)), major bleeding (RR = 0.84; (95% CI, 0.74-0.97)), intracranial hemorrhage (RR = 0.50; 95% CI, 0.43-0.59), and hemorrhagic stroke (RR = 0.49 (95% CI, 0.38-0.63)). There were no differences in the risks of ischemic stroke (RR = 0.89 (95% CI, 0.75-1.04)) and gastrointestinal bleeding (RR = 1.11 (95% CI, 0.79-1.55)) in patients treated with NOACs versus warfarin. Compared with warfarin use, the use of NOACs had similar or lower risks of thromboembolic and bleeding events in patients with AF and HF.