Abstract
BACKGROUND: Thromboembolism is a common complication in elderly patients with non-Valvular Atrial Fibrillation (NVAF). Noval oral anticoagulants (NOACs) remain the primary treatment strategy. This study focuses on the optimal dosage and safety of new oral anticoagulants introduced in recent years. OBJECTIVE: To investigate the optimal dose and safety of NOACs in elderly patients with NVAF through meta-analysis. METHODS: A systematic literature search was conducted using both Chinese and international academic databases to identify studies on NOAC therapy in elderly patients with NVAF. A total of 22 studies were included. Meta-analysis was performed using RevMan 5.3 software. RESULTS: The risk of systemic embolism (SSE) in patients receiving warfarin was significantly higher compared to those on both standard-dose and low-dose NOACs. Patients who take conventional doses of new anticoagulants orally have a higher risk of developing SSE (P < 0.05). The risk of severe bleeding in patients receiving standard-dose warfarin was higher than those on conventional dose and low-dose NOACs. There was no statistically significant difference in the risk of severe bleeding between patients with conventional and low-dose anticoagulants (P > 0.05). Funnel plots for SSE and major bleeding outcomes were symmetrical and centered around the mean, suggesting low publication bias and reliable results. CONCLUSION: Low-dose NOACs demonstrate favorable efficacy and safety in elderly NVAF patients, appearing superior to warfarin and conventional dose NOACs. These findings support the preferential use of NOACs over warfarin in this population.