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October 2, 2018American Journal of Therapeutics

Comparative Clinical Outcomes of Edoxaban in Adults With Nonvalvular Atrial Fibrillation

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Key result

Edoxaban is noninferior to warfarin for stroke and systemic embolism prevention (RR 0.65; 95% CI 0.23-1.81) and reduces cardiovascular mortality, but increases gastrointestinal bleeding.

Why the study?

Does edoxaban reduce stroke and systemic embolism compared to warfarin and other NOACs in adults with nonvalvular atrial fibrillation?

Population

Adults with nonvalvular atrial fibrillation (4 RCTs pooling 23,021 patients)

Comparison

Edoxaban vs Warfarin and other NOACs

Design

Systematic_review

Authors

WAWilbert S. AronowTSTatyana Shamliyan

Discussion

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Overview

Edoxaban provides a practical option versus warfarin in nonvalvular AF; extends pooled RCT evidence while leaving head-to-head data versus other NOACs open.

Study Design

Type

Meta-Analysis (n=23,021)

Structured PICO

Does edoxaban reduce stroke and systemic embolism compared to warfarin and other NOACs in adults with nonvalvular atrial fibrillation?

P
Population
23,021 adults with nonvalvular atrial fibrillation included in a meta-analysis of 4 RCTs comparing edoxaban to warfarin.
I
Intervention
Edoxaban
C
Comparator
Warfarin and other NOACs (apixaban, dabigatran, or rivaroxaban)
O
Outcome
Stroke and systemic embolismhard clinical

Main Result

Relative Risk: 0.65 (95% CI 0.23–1.81)

Edoxaban is noninferior to warfarin for stroke prevention in nonvalvular atrial fibrillation and reduces cardiovascular mortality and major bleeding, though it increases the risk of gastrointestinal bleeding and anemia.

Limitations

  • Reporting bias
  • Small number of events
  • Indirectness in comparisons
  • Comparative data with other novel NOACs are mostly nonexisting

Cite This Study

Aronow et al. (2018) conducted a meta-analysis in nonvalvular atrial fibrillation (n=23,021). Edoxaban vs. Warfarin was evaluated on stroke and systemic embolism (RR 0.65, 95% CI 0.23-1.81). Edoxaban is noninferior to warfarin for stroke and systemic embolism prevention (RR 0.65; 95% CI 0.23-1.81) and reduces cardiovascular mortality, but increases gastrointestinal bleeding.

synapsesocial.com/papers/6a6acdf945e10bb5bcf2cf4dhttps://doi.org/10.1097/mjt.0000000000000848
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Efficacy and Safety of Oral Anticoagulants in Warfarin-Suitable Patients With Nonvalvular Atrial Fibrillation2013 · 46 citations
  2. 2Systematic Review and Adjusted Indirect Comparison Meta-Analysis of Oral Anticoagulants in Atrial Fibrillation2012 · 111 citations
  3. 3Systematic review with meta‐analysis: the risk of major gastrointestinal bleeding with non‐vitamin K antagonist oral anticoagulants2015 · 63 citations
  4. 4Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Systematic Review of Cost-Effectiveness Models2013 · 57 citations
  5. 5Association of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality2018 · 238 citations