Oral Anticoagulation Therapy in Atrial Fibrillation Patients with Intermediate Stroke Risk: A Systematic Review and Meta-Analysis.

BackgroundCurrent guidelines recommend that anticoagulation is reasonable and less robust to prevent stroke among AF patients with an intermediate risk of stroke, suggesting the need for more evidence in this population. Therefore, our current systematic review and meta-analysis aimed to evaluate the effectiveness and safety outcomes of oral anticoagulation (OAC) therapy in AF patients with a single additional stroke risk factor (CHA2DS2-VASc score = 1 in males and 2 in females).MethodsWe performed the literature searches to identify relevant articles by systematically researching the PubMed and Embase databases. In the pooled analysis by the random-effects model, the comparative treatment indicators to present outcomes of OAC therapy compared with no OAC were adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsA total of 6 studies were finally included. In the pooled analysis by the random-effects model, compared with no OAC therapy, OAC use was associated with increased risks of major bleeding (HR = 1.29, 95%CI: 1.06-1.57) and gastrointestinal bleeding (HR = 1.38, 95%CI: 1.04-1.82). There were no differences in stroke or systemic embolism (SSE) (HR = 0.84, 95%CI: 0.66-1.08), ischemic stroke (HR = 0.79, 95%CI: 0.27-2.33), and intracranial bleeding (HR = 1.17, 95%CI: 0.78-1.76) between the two studied groupsConclusionIn patients with AF patients at an intermediate risk of stroke, OAC use was not associated with reductions in thromboembolic events, but might increase the bleeding risks compared with no treatment.