New oral anticoagulants for stroke prevention in atrial fibrillation: impact of gender, heart failure, diabetes mellitus and paroxysmal atrial fibrillation.

The emergence of new oral anticoagulants is a major development in cardiovascular medicine. In this overview, we sought to evaluate the impact of gender, heart failure, paroxysmal atrial fibrillation (AF) and diabetes on stroke prevention with warfarin and the new oral anticoagulants by conducting a semisystematic review and meta-analysis including 44,563 patients in recent contemporary Phase III trials. The new oral anticoagulants were superior to warfarin irrespective of gender or the presence of diabetes. For nonparoxysmal AF, event rates are similar with warfarin and new anticoagulants. There is some suggestion of the benefit of new oral anticoagulants in patients with paroxysmal AF. For patients without heart failure, the new drugs are superior, whereas in patients with evidence of heart failure the new drugs were similar to warfarin. In conclusion, new oral anticoagulants are better than warfarin irrespective of gender or the presence of diabetes mellitus. Patients with heart failure and nonparoxysmal AF seem not to gain additional prognostic benefit from new anticoagulants.