Compared to warfarin, dabigatran 150 mg (rate ratio 0.65; 95% CrI 0.52-0.82) and apixaban (rate ratio 0.82; 95% CrI 0.69-0.97) reduced the risk of all strokes in patients with atrial fibrillation.
Meta-Analysis (n=96,826)
Do novel oral anticoagulants and antiplatelet agents reduce the risk of stroke and bleeding compared to warfarin or placebo in patients with atrial fibrillation?
Novel oral anticoagulants are more effective than antiplatelet agents for stroke prevention in atrial fibrillation, with dabigatran 150 mg and apixaban showing superior stroke reduction compared to warfarin.
Effect estimate: rate ratio 0.65 (95% CI 0.52-0.82)
BACKGROUND: In the last 4 years, four novel oral anticoagulants have been developed as alternatives to warfarin and antiplatelet agents for stroke prevention in atrial fibrillation (AF) patients. The objective of this review was to estimate the comparative effectiveness of all antithrombotic treatments for AF patients. MATERIALS AND METHODS: Data sources were Medline Ovid (1946 to October 2015), Embase Ovid (1980 to October 2015), and the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 9, 2015). Randomized controlled trials of AF patients were selected if they compared at least two of the following: placebo, aspirin, aspirin and clopidogrel combination therapy, adjusted-dose warfarin (target international normalized ratio 2.0-3.0), dabigatran, rivaroxaban, apixaban, and edoxaban. Bayesian network meta-analyses were conducted for outcomes of interest (all stroke, ischemic stroke, myocardial infarction, overall mortality, major bleeding, and intracranial hemorrhage). RESULTS: Based on 16 randomized controlled trials of 96,826 patients, all oral anticoagulants were more effective than antiplatelet agents at reducing the risk of ischemic stroke and all strokes. Compared to warfarin, dabigatran 150 mg (rate ratio 0.65, 95% credible interval 0.52-0.82) and apixaban (rate ratio 0.82, 95% credible interval 0.69-0.97) reduced the risk of all strokes. Dabigatran 150 mg was also more effective than warfarin at reducing ischemic stroke risk (rate ratio 0.76, 95% credible interval 0.59-0.99). Aspirin, apixaban, dabigatran 110 mg, and edoxaban were associated with less major bleeding than warfarin. CONCLUSION: All oral anticoagulants reduce the risk of stroke in AF patients. Some novel oral anticoagulants are associated with a lower stroke and/or major bleeding risk than warfarin. In addition to the safety and effectiveness of drug therapy, as reported in this study, individual treatment recommendations should also consider the patient's underlying stroke and bleeding risk profile.
Tawfik et al. (Mon,) conducted a meta-analysis in atrial fibrillation (n=96,826). Novel oral anticoagulants vs. warfarin and antiplatelet agents was evaluated on all strokes (rate ratio 0.65, 95% CI 0.52-0.82). Compared to warfarin, dabigatran 150 mg (rate ratio 0.65; 95% CrI 0.52-0.82) and apixaban (rate ratio 0.82; 95% CrI 0.69-0.97) reduced the risk of all strokes in patients with atrial fibrillation.