NOACs were favored over warfarin for stroke/systemic embolism and all-cause mortality, with apixaban and dabigatran 110 mg showing significantly lower hazards of major bleeding than other NOACs.
Meta-Analysis (n=50,578)
Do novel oral anticoagulants (apixaban, dabigatran, rivaroxaban) reduce stroke/systemic embolism and mortality compared to warfarin in patients with nonvalvular atrial fibrillation?
NOACs offer a therapeutic advance over warfarin for stroke prevention in nonvalvular atrial fibrillation, with apixaban and dabigatran 110 mg demonstrating a more favorable major bleeding profile compared to other NOACs.
The novel oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban have been recently indicated for stroke prevention in patients with atrial fibrillation (AF) . Due to a lack of direct head-to-head trials comparing the NOACs, the current systematic review and network meta-analysis (NMA) were conducted to assess their relative efficacy and safety. Three phase III randomized controlled trials enrolling 50 578 patients were included. Results of the NMA show a clear trend favoring NOACs over warfarin with regard to the key outcomes of stroke/systemic embolism and all-cause mortality, with apixaban also showing a favorable response for major bleeding and total discontinuations. Although there were few significant differences among the NOACS with regard to efficacy outcomes, apixaban and dabigatran 110 mg were associated with significantly lower hazards of major bleeding compared with dabigatran 150 mg and rivaroxaban. The NOACs offer a therapeutic advance over standard warfarin treatment in stoke prevention in patients with nonvalvular AF.
Mitchell et al. (Wed,) conducted a meta-analysis in nonvalvular atrial fibrillation (n=50,578). NOACs (apixaban, dabigatran, rivaroxaban) vs. warfarin was evaluated on stroke/systemic embolism and all-cause mortality. NOACs were favored over warfarin for stroke/systemic embolism and all-cause mortality, with apixaban and dabigatran 110 mg showing significantly lower hazards of major bleeding than other NOACs.
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