All 3 non-vitamin K antagonist oral anticoagulants similarly effective in nonvalvular Afib

  • Li G & al.
  • Eur J Epidemiol
  • 8 Jun 2018

  • from Sarfaroj Khan
  • Clinical Summaries
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Takeaway

  • In adult patients with nonvalvular atrial fibrillation, risk for stroke or systemic embolism was not significantly different between 3 non-vitamin K antagonist oral anticoagulants (NOACs), rivaroxaban, apixaban and dabigatran.
  • Apixaban was associated with lower risk for major bleeding vs rivaroxaban or dabigatran.
  • Rivaroxaban showed higher risk for major bleeding vs dabigatran.

Why this matters

  • Use of NOACs for stroke prevention in patients with nonvalvular atrial fibrillation has been increasing in clinical practice, but it is unclear if one agent is superior to another.
  • Prospective head-to-head randomised trials are warranted.

Study design

  • Meta-analysis of 12 studies including patients with nonvalvular atrial fibrillation aged ≥18 years who received NOACs for stroke prevention.
  • Primary outcome: stroke or systemic embolism, major bleeding.
  • Funding: No external funding.

Key results

  • No significant difference in risk for stroke or systemic embolism between:
    • rivaroxaban and dabigatran (HR, 1.00; P=.97),
    • apixaban and rivaroxaban (HR, 1.09; P=.19) and
    • dabigatran and apixaban (HR, 0.94; P=.32).
  • Rivaroxaban was associated with higher risk for major bleeding vs dabigatran (HR, 1.39; P<.001>
  • Risk for major bleeding was significantly higher with rivaroxaban vs apixaban (HR, 1.71; P<.001>
  • Apixaban was associated with significantly lower risk for major bleeding vs dabigatran (HR, 0.80; P=.01).

Limitations

  • Non-randomised observational studies were included in the analysis.