• David F Briceno, Pedro Villablanca, Nicole Cyrille, Daniele Massera, Eric Bader, Eric Manheimer, Philip Aagaard, Kevin Ferrick, Jay Gross, Soo Gyum Kim, Andrew Krumerman, Eugen Palma, Nils Guttenplan, Jorge Romero, John Fisher, Mario Garcia, Andrea Natale, and Luigi Di Biase.
• From the Department of Medicine, Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (D.F.B., P.V., N.C., D.M., E.B., E.M., P.A., K.F., J.G., S.G.K., A.K., E.P., N.G., J.R., J.F., M.G., L.D.B.); Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin (A.N., L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (A.N., L.D.B.); Division of Cardiology, Stanford University, Palo Alto, CA (A.N.); Division of Cardiovascular Medicine, Case Western Reserve University, Cleveland, OH (A.N.); Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); Dell Medical School, Austin, TX (A.N.); California Pacific Medical Center, San Francisco (A.N.); and Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B.).
• Circ Arrhythm Electrophysiol. 2015 Oct 1; 8 (5): 1057-64.

BackgroundNonvalvular atrial fibrillation is the most common arrhythmia. Patients with nonvalvular atrial fibrillation are at increased risk of stroke; therefore, we evaluated the efficacy and safety of different approaches to prevent this major complication.Methods And ResultsWe conducted electronic database searches of phase III randomized controlled trials. The groups were novel oral anticoagulants, Watchman left atrial appendage occlusion device (DEVICE), and warfarin. Efficacy outcomes were stroke or systemic embolism, and all-cause mortality. Safety outcome was major bleeding and procedure-related complications. A subgroup analysis of the elderly population was done. We used random-effects model to compare pooled outcomes and tested for heterogeneity. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for each outcome. Seven randomized controlled trials (n=73,978) were included. There was a significant difference favoring novel oral anticoagulants for systemic embolism (OR, 0.84; 95% CI, 0.72-0.97; P=0.01), all-cause mortality (OR, 0.89; 95% CI, 0.84-0.94; P<0.001), and safety outcomes (OR, 0.79; 95% CI, 0.65-0.97; P=0.026) compared with warfarin. No difference was seen between DEVICE and warfarin for efficacy end points; however, DEVICE had more complications (OR, 1.85; 95% CI, 1.14-3.01; P=0.012). In the elderly (6 randomized controlled trials, n=30,699), systemic embolism was favored with novel oral anticoagulants over warfarin (OR, 0.77; 95% CI, 0.68-0.87; P≤0.001). No evidence of significant publication bias was found.ConclusionsNovel oral anticoagulants is superior to warfarin for stroke prevention in nonvalvular atrial fibrillation. This benefit was also observed in the elderly population. DEVICE is a reasonable noninferior alternative to warfarin for stroke prevention, but cautious use is essential given safety concerns.© 2015 American Heart Association, Inc.

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