Bai Y, et al. - The effectiveness and safety of warfarin use compared with warfarin non-use and non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients aged ≥65 years were examined in this systematic review. In older AF patients, warfarin use was superior to warfarin non-use, aspirin and no antithrombotic therapy in reducing the risk of stroke/thromboembolism (TE), but with a possible increase in major bleeding. For stroke/TE prevention, NOACs were superior to warfarin, with reduced risk of major bleeding.

• The researchers searched PubMed and the Cochrane Library.
• Then, they included 26 studies.
• Among them, 10 studies were comparing warfarin with warfarin non-use and 16 were comparing warfarin with NOACs, in older AF patients (≥65 years).

• For stroke/thromboembolism (TE) prevention, warfarin use was superior to no antithrombotic therapy [relative risk (RR) 0.59, 95% confidence interval (CI) 0.51–0.76, I² = 12.3%, n = 8] and aspirin (RR 0.44, 95% CI 0.24–0.64, I² = 0.0%, n = 5).
• A non-significant increase in risk of major bleeding was observed with warfarin use compared with no antithrombotic therapy (RR 1.26, 95% CI 0.99–1.52, I² = 0.0%, n = 7) and aspirin (RR 1.20, 95% CI 0.91–1.50, I² = 0.0%, n = 5).
• For stroke/TE prevention, NOACs were superior to warfarin [hazard ratio (HR) 0.81, 95% CI 0.73–0.89, I² = 56.6%, n = 9].
• Furthermore, NOACs were correlated with reduced risk of major bleeding compared to warfarin (HR 0.87, 0.77–0.97, I² = 86.1%, n = 9).