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January 1, 2012Thrombosis and Haemostasis

An indirect comparison of dabigatran, rivaroxaban and apixaban for atrial fibrillation

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Why the study?

Does the choice of direct oral anticoagulant (dabigatran, rivaroxaban, or apixaban) affect the risk of stroke, systemic embolism, or major bleeding in patients with non-valvular atrial fibrillation?

Population

Patients with non-valvular atrial fibrillation

Comparison

Direct oral anticoagulants vs Indirect comparison against each other

Design

Meta-analysis

Key result

The provided text contains only the journal's editorial board information and no clinical study data.

Authors

JAJack AnsellSMSimon Mantha

Discussion

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Overview

No data available; leaves comparative DOAC bleeding risks in non-valvular AF unresolved pending head-to-head trials.

Key Points

  • The aim was to indirectly compare dabigatran, rivaroxaban, and apixaban for efficacy and safety outcomes in non-valvular atrial fibrillation patients.
  • Estimated odds ratios for selected outcomes of each anticoagulant versus one another.
  • Compared data from large randomized trials assessing these drugs against warfarin.
  • Rivaroxaban shows a higher odds ratio for stroke versus dabigatran 150 mg (OR 1.35, p=0.04).
  • Apixaban had a significantly lower odds ratio for major bleeding compared to dabigatran 150 mg (OR 0.74, p=0.004).
  • No significant efficacy difference found between dabigatran 150 mg and apixaban for preventing stroke.

Study Design

Type

Meta-Analysis

Structured PICO

Does the choice of direct oral anticoagulant (dabigatran, rivaroxaban, or apixaban) affect the risk of stroke, systemic embolism, or major bleeding in patients with non-valvular atrial fibrillation?

P
Population
Patients with non-valvular atrial fibrillation
I
Intervention
Direct oral anticoagulants (dabigatran 110 mg or 150 mg, rivaroxaban, apixaban)
C
Comparator
Indirect comparison against each other
O
Outcome
Stroke or systemic embolismhard clinical

Indirect comparisons suggest apixaban may have a more favorable major bleeding profile than dabigatran 150 mg or rivaroxaban, though these findings require confirmation in direct head-to-head randomized trials.

Limitations

  • Indirect comparison should be used only to generate hypotheses
  • Cohorts differed significantly in CHADS(2) score and history of stroke/TIA/systemic embolism

Cite This Study

Ansell et al. (2012) conducted a meta-analysis in atrial fibrillation. dabigatran, rivaroxaban, apixaban was evaluated. The provided text contains only the journal's editorial board information and no clinical study data.

synapsesocial.com/papers/6a1c36b64cc49ccc94a9173ehttps://doi.org/10.1160/th12-02-0093
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