Evidence map›Paper›PMID 31022899›Full record

ReviewJournal of clinical medicine2019

Effectiveness and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for People Aged 75 Years and over with Atrial Fibrillation: A Systematic Review and Meta-Analyses of Observational Studies.

Anneka Mitchell, Margaret C Watson, Tomas Welsh, Anita McGrogan

Open access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of clinical medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 2 pooled it
4.7field-weighted citation impact, top 4% 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

32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 49 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Observational
  5. Review
  6. Article
  7. Observational
  8. Review
  9. Review
  10. Review
  11. Article
  12. Management and Outcomes of Pulmonary Embolism in the Oldest-Old.International journal of general medicine · 2024
    Article
  13. Article
  14. Article
  15. Article
  16. Review
  17. Article
  18. Article
  19. Article
  20. Observational
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

4 authors at 3 institutions in 1 country.

Anneka MitchellDepartment of Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, UK. am3148@bath.ac.uk.ORCID 0000-0002-9222-3185
Margaret C WatsonDepartment of Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, UK. magswatsonbusiness@gmail.com.ORCID 0000-0002-8198-9273
Tomas WelshResearch Institute for the Care of Older People (RICE), Bath BA1 3NG, UK. tomas.welsh@nhs.net.
Anita McGroganDepartment of Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, UK. a.mcgrogan@bath.ac.uk.ORCID 0000-0003-3855-9400
University of Bath · GBUniversity Hospital Southampton NHS Foundation Trust · GBUniversity of Bristol · GB

Funding

Dunhill Medical Trust RTF109/0117The Dunhill Medical Trust RTF109/0117
6 · The paper itself

Abstract

Older people, are underrepresented in randomised controlled trials of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation (AF). The aim of this study was to combine data from observational studies to provide evidence for the treatment of people aged ≥75 years. Medline, Embase, Scopus and Web of Science were searched. The primary effectiveness outcome was ischaemic stroke. Safety outcomes were major bleeding, intracranial haemorrhage, gastrointestinal bleeding, myocardial infarction, and mortality. Twenty-two studies were eligible for inclusion. Two studies related specifically to people ≥75 years but were excluded from meta-analysis due to low quality; all data in the meta-analyses were from subgroups. The pooled risk estimate of ischaemic stroke was slightly lower for DOACs. There was no significant difference in major bleeding, mortality, or myocardial infarction. Risk of intracranial haemorrhage was 44% lower with DOACs, but risk of GI bleeding was 46% higher. Our results suggest that DOACs may be preferable for the majority of older patients with AF, provided they are not at significant risk of a GI bleed. However, these results are based entirely on data from subgroup analyses so should be interpreted cautiously. There is a need for adequately powered research in this patient group.

Indexed as

agedanticoagulantsatrial fibrillationhemorrhagestroke

Identifiers

PMID31022899
PMCPMC6518135
OpenAlexW2941062613

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.