To assess the risk of gastrointestinal bleeding and intracranial hemorrhage in patients with atrial fibrillation (AF) after the use of rivaroxaban or warfarin. To investigate the effects of rivaroxaban and warfarin on gastrointestinal and intracranial hemorrhage in patients with AF, we searched PubMed, Embase, and Medline from the establishment of databases up to 2020. We finally included 38 observational studies involving 1 312 609 patients for the assessment of intracranial hemorrhage, and 33 observational studies involving 1 332 956 patients for the assessment of gastrointestinal bleeding. The rates of intracranial hemorrhage were 0.55% in the rivaroxaban group versus 0.91% in the warfarin group (OR 0.59; 95% CI 0.53–0.66; p < .00001, I2 = 78%). The rates of gastrointestinal bleeding were 2.63% in patients with rivaroxaban versus 2.48% in those with warfarin (OR 1.06; 95% CI 0.96–1.17; p < .00001, I2 = 94%). Rivaroxaban could significantly reduce the risk of intracranial hemorrhage in patients with AF than warfarin, but the risk of gastrointestinal bleeding remained controversy due to no statistical significant difference. Notably, a subgroup analysis demonstrated that patients in rivaroxaban group with severe chronic renal diseases or undergoing hemodialysis exposed to less gastrointestinal hemorrhage risk than the group from warfarin.

中文翻译：

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利伐沙班和华法林对房颤患者消化道出血和颅内出血风险的影响：系统评价和荟萃分析

评估房颤（AF）患者使用利伐沙班或华法林后胃肠道出血和颅内出血的风险。为了研究利伐沙班和华法林对 AF 患者胃肠道和颅内出血的影响，我们检索了 PubMed、Embase 和 Medline，从数据库建立到 2020 年。我们最终纳入了 38 项观察性研究，涉及 1 312 609 名患者，用于评估颅内出血，以及 33 项观察性研究，涉及 1 332 956 名患者，用于评估胃肠道出血。利伐沙班组颅内出血发生率为 0.55%，华法林组为 0.91%（OR 0.59；95% CI 0.53–0.66；p < .00001，I2 = 78%）。利伐沙班组胃肠道出血率为 2.63%，华法林组为 2.48%（OR 1.06；95% CI 0.96–1.17；p  < .00001，I2 = 94%）。与华法林相比，利伐沙班可显着降低 AF 患者颅内出血的风险，但由于无统计学差异，胃肠道出血风险仍存在争议。值得注意的是，亚组分析表明，与华法林组相比，利伐沙班组患有严重慢性肾脏疾病或接受血液透析的患者胃肠道出血风险较低。