Effectiveness and Safety of Apixaban in over 3.9 Million People with Atrial Fibrillation: A Systematic Review and Meta-Analysis
Key result
Apixaban significantly reduced stroke or systemic embolism compared to VKAs (RR 0.77; 95% CI 0.64-0.93) and dabigatran, and was associated with a lower risk of major bleeding.
Why the study?
Despite extensive real-world data on DOAC safety and effectiveness, study heterogeneity has contributed to inconsistent findings.
Does apixaban improve effectiveness and safety outcomes compared to other DOACs and VKAs in adults with atrial fibrillation?
Population
Over 3.9 million adults aged 18 years or older with AF across 67 studies
Comparison
Apixaban vs other DOACs or VKAs
Design
Systematic review and meta-analysis of randomised controlled trials and non-randomised trials
Authors
Discussion
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Implication
Apixaban may improve safety in real-world AF use; leaves open optimal DOAC selection pending consistent RCTs.
Study Design
Type
Meta-Analysis (n=3,900,000)
Structured PICO
Does apixaban improve effectiveness and safety outcomes compared to other DOACs and VKAs in adults with atrial fibrillation?
P
Population
Over 3.9 million adults with atrial fibrillation taking apixaban for stroke prevention compared to other DOACs or VKAs.
I
Intervention
Apixaban
C
Comparator
Other direct-acting oral anticoagulants (DOACs, specifically dabigatran and rivaroxaban) or vitamin K antagonists (VKAs)
O
Outcome
Stroke/systemic embolism (SE), all-cause mortality, and major bleedinghard clinical
Main Result
Relative Risk: 0.77 (95% CI 0.64–0.93)
In a large meta-analysis of over 3.9 million patients with atrial fibrillation, apixaban demonstrated a superior safety and effectiveness profile compared to VKAs, dabigatran, and rivaroxaban.
Cite This Study
Buckley et al. (2022) conducted a meta-analysis in Atrial Fibrillation (n=3,900,000). Apixaban vs. VKAs and other DOACs was evaluated on stroke/systemic embolism (SE) (RR 0.77, 95% CI 0.64-0.93). Apixaban significantly reduced stroke or systemic embolism compared to VKAs (RR 0.77; 95% CI 0.64-0.93) and dabigatran, and was associated with a lower risk of major bleeding.