Key result
Adding a direct factor Xa inhibitor to guideline-based antiplatelet therapy after acute coronary syndrome significantly reduced major adverse cardiovascular events (OR 0.88; 95% CI 0.82-0.94; NNT=52).
Why the study?
Does the addition of a direct factor Xa inhibitor to guideline-based antiplatelet therapy reduce major adverse cardiovascular events in patients after an acute coronary syndrome?
Meta-Analysis (n=45,651)
Does the addition of a direct factor Xa inhibitor to guideline-based antiplatelet therapy reduce major adverse cardiovascular events in patients after an acute coronary syndrome?
Odds Ratio: 0.88 (95% CI 0.82–0.94)
Number Needed to Treat: 52
Adding a direct factor Xa inhibitor to guideline-based antiplatelet therapy after acute coronary syndrome reduces ischemic events but significantly increases major bleeding and intracranial hemorrhage.
Reduces MACE after ACS but increases major bleeding; confirms net ischemic benefit of factor Xa inhibitors on antiplatelet therapy.
OBJECTIVE: We carried out a meta-analysis summarizing the efficacy and safety of direct factor Xa inhibitor (DXI) in patients receiving guideline-based antiplatelet therapy (GBAT) after an acute coronary syndrome. BACKGROUND: Randomized-controlled trials have shown that the addition of a DXI to GBAT after acute coronary syndrome can reduce ischemic events, the trade-off being an increase in major bleeding complications. METHODS: PubMed, Central, Embase, The Cochrane Register, Google Scholar databases, and the scientific session abstracts were searched for eligible randomized trials from 1 January 1990 through 31 December 2016. RESULTS: Nine randomized-controlled trials were included in this meta-analysis enrolling a total of 45651 patients. There was a significant reduction in major adverse cardiovascular events with DXIs/GBAT compared with GBAT alone [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.82-0.94, number needed to treat=52]. There were also significant reductions in two individual components of major adverse cardiovascular events: myocardial infarction (OR: 0.89; 95% CI: 0.81-0.98) and stent thrombosis (OR: 0.73; 95% CI: 0.59-0.90), favoring the DXI/GBAT group. There was an increased risk of major bleeding (OR: 2.51; 95% CI: 1.82-3.46) and intracranial hemorrhage (OR: 3.47; 95% CI: 1.76-6.86) compared with GBAT. CONCLUSION: In acute coronary syndromes, the addition of a DXI to GBAT results in a significant reduction of major adverse cardiovascular events, myocardial infarction, and stent thrombosis, offset by an increased risk of bleeding.
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Villablanca et al. (2017) conducted a meta-analysis in acute coronary syndrome (n=45,651). Direct factor Xa inhibitor (DXI) vs. Guideline-based antiplatelet therapy (GBAT) alone was evaluated on major adverse cardiovascular events (OR 0.88, 95% CI 0.82-0.94). Adding a direct factor Xa inhibitor to guideline-based antiplatelet therapy after acute coronary syndrome significantly reduced major adverse cardiovascular events (OR 0.88; 95% CI 0.82-0.94; NNT=52).
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