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Clinical Summary

Afib: are factor Xa inhibitors comparable with VKAs for preventing blood clots?

Takeaway

  • In this Cochrane review, factor Xa inhibitor vs vitamin K antagonist (VKA) appeared to be an effective treatment for prevention of stroke or systemic embolic events in patients with Afib, who are eligible for long-term anticoagulation.
  • However, absolute overall reduction was small.
  • Treatment with factor Xa inhibitors also reduced the number of intracranial haemorrhages, all-cause deaths and major bleedings vs warfarin.

Why this matters

  • Despite recent European and American guidelines recommending apixaban, dabigatran, edoxaban and rivaroxaban, many people would still be treated with relatively cheaper VKAs.

Study design

  • This Cochrane review evaluated 13 randomised controlled trials involving 67,688 patients with Afib who received either a factor Xa inhibitor or VKA.
  • Trials compared dose-adjusted warfarin with either apixaban, betrixaban, darexaban, edoxaban, idraparinux, idrabiotaparinux or rivaroxaban.
  • Funding:  South-Eastern Norway Regional Health Authority, Norway.

Key results

  • Factor Xa inhibitor significantly reduced number of strokes and other systemic embolic events vs dose-adjusted warfarin (OR, 0.89; 95% CI, 0.82-0.97; I2, 13%).
  • Number of all types of stroke (OR, 0.89; 95% CI, 0.81-0.97; I2, 18%) and all-cause death (OR, 0.89; 95% CI, 0.83-0.95; I2, 0%) was significantly less with factor Xa inhibitor vs warfarin treatment.
  • Intracranial haemorrhages (OR, 0.50; 95% CI, 0.42-0.59; I2, 55%) and major bleedings (OR, 0.78; 95% CI, 0.73-0.84; I2, 83%) also reduced with factor Xa inhibitor vs warfarin treatment; however, moderate heterogeneity was observed.

Limitations

  • Moderate-to-high heterogeneity for some analysis.

References


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