Compared to placebo, antiembolic therapies including NOACs, VKA, aspirin, and the Watchman device significantly reduced stroke or systemic embolism in nonvalvular AF (ORs ranging from 0.27 to 0.75).
Meta-Analysis (n=96,017)
Do antiembolic interventions (NOACs, VKA, aspirin, Watchman device) reduce stroke and systemic embolism in patients with nonvalvular atrial fibrillation?
A network meta-analysis demonstrates that NOACs, VKA, aspirin, and the Watchman device all significantly reduce the risk of stroke, systemic embolism, and all-cause mortality compared to placebo or control in patients with nonvalvular atrial fibrillation.
Effect estimate: OR 0.27-0.75 (95% CI 0.16-0.95)
BACKGROUND: The goal of this study was to compare the safety and effectiveness of individual antiembolic interventions in nonvalvular atrial fibrillation (AF): novel oral anticoagulants (NOACs) (apixaban, dabigatran, edoxaban, and rivaroxaban); vitamin K antagonists (VKA); aspirin; and the Watchman device. METHODS AND RESULTS: A network meta-analysis of randomized, clinical trials (RCTs) was performed. RCTs that included patients with prosthetic cardiac valves or mitral stenosis, mean or median follow-up <6 months, <200 participants, without published report in English language, and NOAC phase II studies were excluded. The placebo/control arm received either placebo or no treatment. The primary efficacy outcome was the combination of stroke (of any type) and systemic embolism. All-cause mortality served as a secondary efficacy outcome. The primary safety outcome was the combination of major extracranial bleeding and intracranial hemorrhage. A total of 21 RCTs (96 017 nonvalvular AF patients; median age, 72 years; 65% males; median follow-up, 1.7 years) were included. In comparison to placebo/control, use of aspirin (odds ratio OR, 0.75 95% CI, 0.60-0.95), VKA (0.38 0.29-0.49), apixaban (0.31 0.22-0.45), dabigatran (0.29 0.20-0.43), edoxaban (0.38 0.26-0.54), rivaroxaban (0.27 0.18-0.42), and the Watchman device (0.36 0.16-0.80) significantly reduced the risk of any stroke or systemic embolism in nonvalvular AF patients, as well as all-cause mortality (aspirin: OR, 0.82 0.68-0.99; VKA: 0.69 0.57-0.85; apixaban: 0.62 0.50-0.78; dabigatran: 0.62 0.50-0.78; edoxaban: 0.62 0.50-0.77; rivaroxaban: 0.58 0.44-0.77; and the Watchman device: 0.47 0.25-0.88). Apixaban (0.89 0.80-0.99), dabigatran (0.90 0.82-0.99), and edoxaban (0.89 0.82-0.96) reduced risk of all-cause death as compared to VKA. CONCLUSIONS: The entire spectrum of therapy to prevent thromboembolism in nonvalvular AF significantly reduced stroke/systemic embolism events and mortality.
Tereshchenko et al. (Fri,) conducted a meta-analysis in nonvalvular atrial fibrillation (n=96,017). Antiembolic interventions (NOACs, VKA, aspirin, Watchman device) vs. Placebo or no treatment was evaluated on Combination of stroke (of any type) and systemic embolism (OR 0.27-0.75, 95% CI 0.16-0.95). Compared to placebo, antiembolic therapies including NOACs, VKA, aspirin, and the Watchman device significantly reduced stroke or systemic embolism in nonvalvular AF (ORs ranging from 0.27 to 0.75).