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