Dabigatran, rivaroxaban, and apixaban are superior to warfarin in Asian patients with non-valvular atrial fibrillation: An updated meta-analysis

Table 1 Baseline characteristics of included studies

Ref.	Design	Setting/data source	Country/region	Study period	Major eligibility criteria	Major exclusion criteria	OAC comparison groups	Outcomes of interest
Chan et al[25], 2016	Database, retrospective cohort study	National Health Insurance Research Database	Taiwan	June 1, 2012 to December 31, 2013	NVAF patients, age ≥ 30 years old	PE or DVT, joint replacement or valvular surgery within 6 mo before AF was diagnosed, ESRD, switcher from dabigatran to warfarin	Dabigatran vs warfarin	Ischemic stroke, intracranial hemorrhage, major GI bleeding, all-cause mortality
Yap et al[26], 2016	Single-center, retrospective cohort study	Malaysia’s National Heart Institute	Malaysia	January, 2009 to December, 2013	NVAF patients	Not mentioned	Dabigatran vs warfarin	Ischemic CVA, major bleeding
Cha et al[27], 2017	Database, retrospective cohort study	Korean National Health Insurance Service database	Korea	January, 2014 to December, 2015	NVAF patients with CHA2DS2-VASc score ≥ 2 taking anticoagulants for primary prevention of stroke/systemic embolism	Thromboembolic event/TIA or ICH, patients received joint replacement, medications change between warfarin and NOACs	Dabigatran vs warfarin, rivaroxaban vs warfarin, apixaban vs warfarin	Ischemic stroke, intracranial hemorrhage, or all-cause mortality
Kohsaka et al[28], 2017	Database, retrospective cohort study	275 acute care hospitals across Japan	Japan	March 1, 2011 to March 31, 2016	NVAF patients 18 yr or older without use of any OAC within 180 d before the index date	Valvular AF, post-operative AF, mechanical-valvular AF, rheumatic AF	Dabigatran vs warfarin, rivaroxaban vs warfarin, apixaban vs warfarin	Major bleeding
Chan et al[29], 2018	Database, retrospective cohort study	National HealthInsurance Research Database	Taiwan	June 1, 2012 to December 31, 2016	NVAF patients ≥ 30 years old	More than 1 NOAC use during treatment course, diagnosis of valvular AF, VTE or joint replacement therapy, ESRD requiring renal replacement therapy within 6 mo before the index date	Dabigatran vs warfarin, rivaroxaban vs warfarin, apixaban vs warfarin	All-cause mortality, intracranial hemorrhage, GI bleeding, major bleeding
Huang et al[30], 2018	Database, retrospective cohort study	National Health Insurance Research Database	Taiwan	June 1, 2012 to December 31, 2015	NVAF patients ≥ 20 years old, at least 1 inpatient or 2 separate outpatient diagnoses of AF	Prosthetic heart valve or MV disease during the study period, pregnant, cancer, or chronic dialysis within 12 months prior to index date	Rivaroxaban vs warfarin	Ischemic stroke, intracranial hemorrhage, GI bleeding
Okumura et al[31], 2018	Multi-center, prospective cohort study	63 institutions in the Tokyo area	Japan	September 1, 2013 to December 31, 2015	NVAF patients, age ≥ 20 years old, treatment with any anticoagulant drug for stroke prophylaxis	Not mentioned	Dabigatran vs warfarin, rivaroxaban vs warfarin, apixaban vs warfarin	Intracranial hemorrhage, major bleeding, all-cause mortality
Koretsune et al[32], 2018	Database, retrospective cohort study	Hospital Information systems and administration database by Medical Data Vision	Japan	March 14, 2011 to June 30, 2016	NVAF patients, age ≥ 18, new user of either dabigatran or warfarin	Dialysis, kidney transplant, atrial flutter, valvular AF, mechanical valve replacement, rheumatic AF or MV prolapse/regurgitation or stenosis; or DVT or PE < 6 months before the AF diagnosis	Dabigatran vs warfarin	Major bleeding, intracranial hemorrhage, GI bleeding
Chan et al[33], 2019	Database, retrospective cohort study	National Health Insurance Research Database	Taiwan	June 1, 2012 to December 31, 2017	NVAF patients	More than one NOAC use, ESRD, DVT, PE, joint replacement therapy up to 6 mo prior to the index date.	Dabigatran vs warfarin, rivaroxaban vs warfarin, apixaban vs warfarin	Ischemic stroke, intracranial hemorrhage, major bleeding, major GI bleeding
Jeong et al[34], 2019	Single-center, retrospective cohort study	Chonnam National University Hospital	Korea	January, 2014 to December, 2016	NVAF patients, CHA2DS2-VASc > 2	Valvular AF, or any OAC class change	Rivaroxaban vs warfarin	Ischemic stroke, major bleeding, GI bleeding, intracranial bleeding, all-cause mortality
Lee et al[35], 2019	Database, retrospective cohort study	Korean Health Insurance Review Database	Korea	January, 2015 to December, 2017	NVAF patients naïve to OAC treatment	Not mentioned	Dabigatran vs warfarin, rivaroxaban vs warfarin, apixaban vs warfarin	Ischemic stroke, intracranial hemorrhage, GI bleeding, major bleeding
Cho et al[36], 2019	Database, retrospective cohort study	Korean National Health Insurance Service	Korea	July 1, 2015 to December 31, 2016	NVAF patients with new prescription of anticoagulants, age ≥ 18	Less than 30 d of anticoagulants use, two or more types of anticoagulants user, CHA2DS2-VASc score < 2, prior PE or DVT, underwent joint replacement surgery, dialysis patients	Dabigatran vs warfarin, rivaroxaban vs warfarin, apixaban vs warfarin	All-cause mortality, major bleeding

NVAF: Nonvalvular atrial fibrillation; OAC: Oral anticoagulant; DVT: Deep venous thrombosis; PE: Pulmonary embolism; MV: Mitral valve; ESRD: End stage renal disease; GI: Gastrointestinal.