The Safety and Efficacy of Rivaroxaban Compared with Warfarin in Patients with Atrial Fibrillation and Diabetes: A Systematic Review and Meta-analysis.

AIMS: This meta-analysis was conducted to compare the efficacy and safety of rivaroxaban with warfarin in patients with atrial fibrillation (AF) and diabetes mellitus. METHODS: PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched from the establishment of databases up to 15 October 2019. Studies on efficacy and safety outcomes of rivaroxaban and warfarin were included. Efficacy and safety outcomes, including stroke, ischemic stroke, stroke or systemic embolism, myocardial infarction, major adverse cardiac events, major bleeding, intracranial hemorrhage, and major gastrointestinal bleeding were collected for meta-analysis. RESULTS: Compared with warfarin, rivaroxaban could significantly reduce stroke (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.63-0.95; P = 0.01), ischemic stroke (RR 0.74; 95% CI 0.63-0.87; P = 0.0004), stroke or systemic embolism (RR 0.73; 95% CI 0.60-0.89; P = 0.002), myocardial infarction (RR 0.68; 95% CI 0.56-0.82; P < 0.0001), and major adverse cardiac events (RR 0.71; 95% CI 0.53-0.94; P = 0.02) in patients with AF and diabetes. Moreover, rivaroxaban was associated with a lower risk of major bleeding (RR 0.79; 95% CI 0.65-0.96; P = 0.02), intracranial hemorrhage (RR 0.52; 95% CI 0.39-0.69; P < 0.00001), and major gastrointestinal bleeding (RR 0.74; 95% CI 0.56-0.98; P = 0.04). Similar results were obtained in stratified meta-analysis of cohort studies. CONCLUSION: Our study suggests a favorable risk-benefit profile of rivaroxaban, with superior efficacy and safety over warfarin in patients with AF and diabetes.

[Clinical efficacy observation on paroxysmal atrial fibrillation treated by acupuncture combined with Wenxin granule].

OBJECTIVE: To compare the difference of clinical efficacy in the treatment of paroxysmal atrial fibrillation (PAF) between acupuncture combined with Wenzin granule and simple Wenxin granule therapy. METHODS: Sixty hospitalized cases of PAF were randomized into a medication group and a medication--acupuncture group. Wenxin granule was given to the patients in the two groups 3 times a day, 9 g each time, 4 weeks as a treatment course. Meanwhile, acupuncture was added to the medication--acupuncture group at bilateral Neiguan (PC 6), Shenmen (HT 7), Ximen (PC 4) with uneven reinforcing-reducing manipulation every 15 min, 1 min each time. The needle was retained for 30 minutes. The acupuncture was given once daily for continuously 4 weeks. The therapeutic efficacy of the two groups was assessed after treatment. METHODS: In the medication+acupuncture group, 18 cases were markedly effective, 10 cases were effective and 2 cases were failed, the total effective rate was 93.3%; in the medication group, 15 cases were markedly effective, 8 cases were effective and 7 cases were failed, the total effective rate was 76.7%. There were statistical significances in clinical efficacy between the two groups (P<0.05). CONCLUSION: Acupuncture combined with Wenxin granule has a better effect than simple Wenxin granule therapy in the treatment of paroxysmal atrial fibrillation.