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September 5, 2013Heart

Current and new oral antithrombotics in non-valvular atrial fibrillation: a network meta-analysis of 79 808 patients

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Why the study?

Do novel oral anticoagulants and other antithrombotics reduce stroke, embolism, and mortality compared to placebo or each other in patients with non-valvular atrial fibrillation?

Population

79,808 patients with non-valvular atrial fibrillation pooled from 20 randomized controlled trials

Comparison

Oral antithrombotics including ASA, ASA plus… vs Placebo/control or active comparators within the…

Design

Meta-analysis

Key result

Novel oral anticoagulants ranked better than VKA or antiplatelet therapies, with dabigatran 150 mg showing the lowest risk of stroke compared to placebo/control (OR 0.25; 95% CrI 0.15-0.43).

Authors

ADAriel DogliottiEPErnesto PaolassoRGRobert P. Giugliano

Discussion

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Member takes

Overview

Supports preferring NOACs over VKA or antiplatelets for stroke prevention in non-valvular AF; extends network rankings with placebo comparisons.

Study Design

Type

Meta-Analysis (n=79,808)

Structured PICO

Do novel oral anticoagulants and other antithrombotics reduce stroke, embolism, and mortality compared to placebo or each other in patients with non-valvular atrial fibrillation?

P
Population
79,808 patients with non-valvular atrial fibrillation pooled from 20 randomized controlled trials
I
Intervention
Oral antithrombotics including ASA, ASA plus clopidogrel, vitamin K antagonists (VKAs), dabigatran 110 mg, dabigatran 150 mg, rivaroxaban, and apixaban
C
Comparator
Placebo/control or active comparators within the network
O
Outcome
Multiple endpoints including stroke, embolism, death and bleedinghard clinical

Main Result

Effect estimate: OR 0.25 (95% CI 0.15-0.43)

In a network meta-analysis, novel oral anticoagulants ranked better than vitamin K antagonists or antiplatelet therapies for the prevention of stroke, systemic embolism, and mortality in non-valvular atrial fibrillation.

Cite This Study

Dogliotti et al. (2013) conducted a meta-analysis in non-valvular atrial fibrillation (n=79,808). Novel oral anticoagulants (dabigatran, rivaroxaban, apixaban) vs. ASA, ASA plus clopidogrel, vitamin K antagonists (VKAs), or placebo/control was evaluated on Stroke (OR 0.25, 95% CI 0.15-0.43). Novel oral anticoagulants ranked better than VKA or antiplatelet therapies, with dabigatran 150 mg showing the lowest risk of stroke compared to placebo/control (OR 0.25; 95% CrI 0.15-0.43).

synapsesocial.com/papers/6a16eed225571367076bc2c0https://doi.org/10.1136/heartjnl-2013-304347
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