Evidence map›Paper›PMID 28720644›Full record

SynthesisJournal of the American Heart Association2017

Effects of Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease: A Systematic Review and Meta-Analysis.

Kuo-Li Pan, Daniel E Singer, Bruce Ovbiagele, Yi-Ling Wu, Mohamed A Ahmed, Meng Lee

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of the American Heart Association, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 65 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
65citing papers in PubMed, 9 pooled it
9.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

65 citing papers in PubMed, 9 syntheses or guidelines pooled it, 151 citations in OpenAlex.

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  16. The Year in Cardiology-Practice Changing Trials from European Society of Cardiology Congress 2023.The International journal of angiology : official publication of the International College of Angiology, Inc · 2025
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5 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 3 countries.

Kuo-Li PanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Chiayi, Puzi, Taiwan.
Daniel E SingerDivision of General Internal Medicine, Massachusetts General Hospital, Boston, MA.
Bruce OvbiageleDepartment of Neurology, Medical University of South Carolina, Charleston, SC.
Yi-Ling WuResearch Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan.
Mohamed A AhmedEpidemiology and Biostatistics Department, American University of Beirut, Lebanon.
Meng LeeDepartment of Neurology, Chang Gung University College of Medicine Chang Gung Memorial Hospital at Chiayi, Puzi, Taiwan menglee5126@gmail.com.
Chang Gung University · TWAmerican University of Beirut · LBChiayi Chang Gung Memorial Hospital · TWHarvard University · USMedical University of South Carolina · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe original non-vitamin K antagonist oral anticoagulant (NOAC) trials in nonvalvular atrial fibrillation (AF) enrolled patients with native valve pathologies. The object of this study was to quantify the benefit-risk profiles of NOACs versus warfarin in AF patients with native valvular heart disease (VHD). METHODS AND

resultsTrials were identified by exhaustive literature search. Trial data were combined using inverse variance weighting to produce a meta-analytic summary hazard ratio (HR) and 95% confidence interval (CI) of efficacy and safety of NOACs versus warfarin. Our final analysis included 4 randomized controlled trials that enrolled 71 526 participants, including 13 574 with VHD. Pooling results from included trials showed that NOACs versus warfarin reduced stroke or systemic embolism (HR: 0.70; 95% CI, 0.60-0.82) and intracranial hemorrhage (HR: 0.47; 95% CI, 0.24-0.92) in AF patients with VHD. However, risk reduction of major bleeding and intracranial hemorrhage was driven by apixaban, edoxaban, and dabigatran (HR for major bleeding: 0.79 [95% CI, 0.69-0.91]; HR for intracranial hemorrhage: 0.33 [95% CI, 0.25-0.45]) but not rivaroxaban (HR for major bleeding: 1.56 [95% CI, 1.20-2.04]; HR for intracranial hemorrhage: 1.27 [95% CI, 0.77-2.10]).

conclusionsAmong patients with AF and native VHD, NOACs reduce stroke and systemic embolism compared with warfarin. Evidence shows that apixaban, dabigatran, and edoxaban also reduce bleeding in this patient subgroup, whereas major bleeding (but not intracranial hemorrhage or mortality rate) is significantly increased in VHD patients treated with rivaroxaban. NOACs are a reasonable alternative to warfarin in AF patients with VHD.

Indexed as

Administration, OralAgedAged, 80 and overAnticoagulantsAtrial FibrillationBlood CoagulationChi-Square DistributionFemaleHeart Valve DiseasesHemorrhageHumansIntracranial HemorrhagesMaleMiddle AgedOdds RatioRisk FactorsAnticoagulantsVitamin KWarfarinanticoagulantatrial fibrillationbleedingstrokevalve

Identifiers

PMID28720644
PMCPMC5586302
OpenAlexW2737130990

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.