DOACs were associated with lower risk of TE/stroke compared to VKAs (e.g., apixaban HR 0.75; 95% CI 0.65-0.86), and lower risk of intracranial hemorrhage compared to VKAs.
Meta-Analysis
Do DOACs reduce the risk of ischaemic stroke, thromboembolism, and intracranial haemorrhage compared to VKAs or other DOACs in patients with nonvalvular atrial fibrillation?
DOACs are associated with a lower risk of thromboembolism/stroke and intracranial hemorrhage compared to VKAs in nonvalvular atrial fibrillation, with differences in safety and efficacy profiles among individual DOACs.
Effect estimate: HR 0.82 (95% CI 0.68-0.99)
AIMS: Observational studies have investigated the effectiveness and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) used in nonvalvular atrial fibrillation. We performed a systematic review and meta-analysis assessing the risk of ischaemic stroke, thromboembolism (TE) and intracranial haemorrhage (ICH) associated with the use of DOACs and VKAs. METHODS: Medline and Embase were systematically searched until April 2021. Observational studies were gathered and hazard ratios (HRs) with 95% confidence intervals (CI) were extracted. Subgroup analyses based on DOAC doses, history of chronic kidney disease, stroke, exposure to VKA, age and sex were performed. A random-effects model was used. RESULTS: We included 92 studies and performed 107 comparisons. Apixaban was associated with lower risk of stroke (HR: 0.82, 95% CI: 0.68-0.99) compared to dabigatran. Rivaroxaban was associated with lower risk of stroke (HR: 0.90, 95% CI: 0.83-0.98) compared to VKA. Dabigatran (HR: 0.85, 95% CI: 0.80-0.91), rivaroxaban (HR: 0.83, 95% CI: 0.77-0.89) and apixaban (HR: 0.75, 95% CI: 0.65-0.86) were associated with lower risk for TE/stroke compared to VKA. Apixaban (HR: 1.32, 95% CI: 1.03-1.68) and rivaroxaban (HR: 1.58, 95% CI: 1.31-1.89) were associated with higher risk of ICH compared to dabigatran. Dabigatran (HR: 0.48, 95% CI: 0.44-0.52), apixaban (HR: 0.60, 95% CI: 0.49-0.73) and rivaroxaban (HR: 0.73, 95% CI: 0.65-0.81) were associated with lower risk of ICH compared to VKA. CONCLUSION: Our study demonstrated significant differences in the risk of ischaemic stroke, TE/stroke and ICH associated with individual DOACs compared to both other DOACs and VKA.
Archontakis‐Barakakis et al. (Tue,) conducted a meta-analysis in nonvalvular atrial fibrillation. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) and other DOACs was evaluated on ischaemic stroke, thromboembolism (TE) and intracranial haemorrhage (ICH) (HR 0.82, 95% CI 0.68-0.99). DOACs were associated with lower risk of TE/stroke compared to VKAs (e.g., apixaban HR 0.75; 95% CI 0.65-0.86), and lower risk of intracranial hemorrhage compared to VKAs.