NOACs vs Warfarin for Heart Failure Patients With AF

Sarfaroj Khan

April 21, 2020


  • In patients with atrial fibrillation (AF) and heart failure (HF), the use of non-vitamin K antagonist oral anticoagulants (NOACs) was associated with similar or lower risks for thromboembolic and bleeding events compared with warfarin.

Why this matters

  • Findings suggest that NOACs might be reasonable alternatives to warfarin in patients with AF and HF.

Study design

  • Meta-analysis of nine studies (4 randomised controlled trials and 5 observational studies) compared the efficacy and safety outcomes of NOACs with warfarin in patients with AF and HF.

  • Funding: None.

Key results

  • NOACs vs warfarin use was associated with significant reduction in the risk of:

    • stroke or systemic embolism (risk ratio [RR], 0.82; 95% CI, 0.73-0.92; P=.001);

    • all-cause death (RR, 0.87; 95% CI, 0.80-0.94; P=.0007; I2=64%);

    • major bleeding (RR, 0.84; 95% CI, 0.74-0.97; P=.01; I2=82%); and

    • intracranial haemorrhage (RR, 0.50; 95% CI, 0.43-0.59) and haemorrhagic stroke (RR, 0.49; 95% CI, 0.38-0.63; P<.00001 for both).

  • No significant differences were observed between NOACs vs warfarin use in the risk for ischaemic stroke (RR, 0.89; 95% CI, 0.75-1.04; P=.15) and gastrointestinal bleeding (RR, 1.11; 95% CI, 0.79-1.55; P=.54; I2=89%).


  • Subgroup analyses based on the type or dosage of NOACs not performed.

  • Heterogeneity among studies.

  • Risk of residual confounding.


Chen F, Zhou Y, Wan Q, Yu P, Ma J, Hu J. Effect of non-vitamin K antagonist oral anticoagulants versus warfarin in heart failure patients with atrial fibrillation. Heart Fail Rev. 2020 Apr 06 [Epub ahead of print]. doi: 10.1007/s10741-020-09946-8. PMID: 32249407.  View abstract 

This clinical summary first appeared on Univadis from Medscape.


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