Galvain, T, Hill, R, Donegan, S, Lisboa, P, Lip, GYH and Czanner, G (2022) Efficacy and Safety of Anticoagulants in Patients with Atrial Fibrillation and History of Falls or Risk of Falls: A Systematic Review and Multilevel Meta-Analysis. Drug Safety, 45 (11). pp. 1349-1362. ISSN 0114-5916

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Abstract

Introduction: Atrial fibrillation (AF) is a major cause of stroke. Anticoagulants substantially reduce risk of stroke but are also associated with an increased risk of bleeding. Because of that, many patients do not receive anticoagulants, particularly patients at risk of falls. This systematic review and meta-analysis aims to compare anticoagulant treatment options for the management of atrial fibrillation patients at risk of falls or with a history of falls. Methods: We conducted a PRISMA systematic review (until March 2022), including studies evaluating safety and efficacy of different anticoagulants (vitamin K antagonist [VKA] versus non-vitamin K antagonist oral anticoagulant [NOAC]). Outcomes were ischemic stroke, major bleeding, intracranial hemorrhage, hemorrhagic stroke, myocardial infarction, gastrointestinal bleeding, cardiovascular and all-cause mortality. A multilevel meta-analysis was conducted adjusting for clustering effects within studies examining more than one effect size. Results: A total of 919 articles were identified, 848 after removing duplicates. The full text of 155 were screened and 10 articles were retained for final quantitative synthesis. Risk of bias was moderate to serious for the included studies. In meta-analysis, NOACs were associated with superior effectiveness compared with VKA for ischemic stroke/systemic embolism (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.69–0.98; p < 0.05) and safety (HR 0.53, 95% CI 0.40–0.71; p < 0.05) for intracranial hemorrhage. There were no differences in other outcomes. Conclusion: NOACs were associated with less intracranial hemorrhages and ischemic strokes/systemic embolisms than VKAs in AF patients at risk of falls. These findings suggesting preferred use of NOACs over VKAs have clinical implications for physicians, patients and policy makers.

Item Type:	Article
Additional Information:	This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s40264-022-01231-x
Uncontrolled Keywords:	Humans; Intracranial Hemorrhages; Atrial Fibrillation; Gastrointestinal Hemorrhage; Anticoagulants; Administration, Oral; Accidental Falls; Stroke; Ischemic Stroke; Accidental Falls; Administration, Oral; Anticoagulants; Atrial Fibrillation; Gastrointestinal Hemorrhage; Humans; Intracranial Hemorrhages; Ischemic Stroke; Stroke; 1115 Pharmacology and Pharmaceutical Sciences; Pharmacology & Pharmacy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine
Divisions:	Computer Science & Mathematics
Publisher:	Springer
SWORD Depositor:	A Symplectic
Date Deposited:	17 Feb 2023 12:48
Last Modified:	19 Sep 2023 00:50
DOI or ID number:	10.1007/s40264-022-01231-x
URI:	https://researchonline.ljmu.ac.uk/id/eprint/18823

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