Conclusion
This meta-analysis finds no differences in the rates of SSE but increased risk of all-cause death and major bleeding between moderate polypharmacy and severe polypharmacy versus no-polypharmacy patients. In patients with AF and polypharmacy, NOACs showed advantages over VKAs in SSE and any bleeding, and non-inferiority in major bleeding, ischemic stroke, all-cause death, intracranial hemorrhage, and gastrointestinal bleeding. In addition, all primary and secondary outcomes of NOACs and VKAs were compared at similar rates between AF patients with and without polypharmacy.