1. Restarting of anticoagulation in patients with atrial fibrillation after major bleeding: A meta‐analysis
- Author
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Daihua Liu, Jie Liu, Haiyan Feng, Yujie Guo, and Ying Zhou
- Subjects
Gastrointestinal bleeding ,medicine.medical_specialty ,Hemorrhage ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Thromboembolism ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Blood Coagulation ,Retrospective Studies ,Pharmacology ,business.industry ,Warfarin ,Anticoagulants ,Atrial fibrillation ,Retrospective cohort study ,medicine.disease ,Confidence interval ,Relative risk ,Meta-analysis ,Gastrointestinal Hemorrhage ,business ,Major bleeding ,medicine.drug - Abstract
WHAT IS KNOWN AND OBJECTIVE Benefits and risks of restarting oral anticoagulants (OACs) in patients with atrial fibrillation after major bleeding remain unknown. A meta-analysis was performed to systematically evaluate the effects of restarting OACs on thromboembolism and bleeding events in these patients. METHODS Relevant studies were obtained via systematically search of PubMed, Cochrane's Library and Embase databases. A randomized-effect model was used to pool the results. Subgroup analyses according to the types of OACs and sites of reoccurred bleeding were performed. RESULTS AND DISCUSSION Seven retrospective cohort studies with 12 197 patients were included. Restarting OACs was associated with reduced risk of thromboembolism (risk ratio [RR]: 0.61, 95% confidence interval [CI]: 0.42-0.87; P = .007). Subgroup analyses showed that restarting warfarin reduced risk of thromboembolism (RR = 0.59, P = .05), but not for the new oral anticoagulants (NOACs; RR = 1.37, P = .18). Moreover, restarting OACs did not affect the risk of reoccurred bleeding (RR = 0.98, 95% CI: 0.74-1.30, P = .89). Similar results were found for warfarin and NOACs, as well as for reoccurred intracranial haemorrhage or gastrointestinal bleeding. In addition, restarting OACs was associated with significantly reduced risk of all-cause mortality (RR = 0.42, 95% CI: 0.33-0.52, P
- Published
- 2020