| Title: |
Comparative effectiveness of novel oral anticoagulants for atrial fibrillation: evidence from pair-wise and warfarin-controlled network meta-analyses. |
| Authors: |
Biondi Zoccai G; Malavasi V; Abbate A; Agostoni P; Lotrionte M; Van Tassell B; Casali E; Marietta M; Modena MG; Ellenbogen KA; Frati G.; D'ASCENZO, FABRIZIO; CASTAGNO, Davide |
| Contributors: |
Biondi-Zoccai G; Malavasi V; D'Ascenzo F; Abbate A; Agostoni P; Lotrionte M; Castagno D; Van Tassell B; Casali E; Marietta M; Modena MG; Ellenbogen KA; Frati G |
| Publication Year: |
2013 |
| Collection: |
Università degli studi di Torino: AperTo (Archivio Istituzionale ad Accesso Aperto) |
| Subject Terms: |
Apixaban; atrial fibrillation; dabigatran; Meta-analysi; rivaroxaban; Systematic review; Warfarin |
| Description: |
INTRODUCTION: Novel oral anticoagulants have been tested against warfarin for atrial fibrillation, yet no direct comparison is available. We thus aimed to perform pair-wise (direct) and warfarin-adjusted network (i.e. indirect) meta-analyses of novel oral anticoagulants for atrial fibrillation. METHODS: Databases were searched for randomized warfarin-controlled trials of novel anticoagulants for non-valvular atrial fibrillation. The primary end-point was long-term stroke/systemic embolism. Odds ratios (95% intervals) were computed with RevMan and WinBUGS. RESULTS: Seven trials (52701 patients) were included, focusing on apixaban, dabigatran, edoxaban and rivaroxaban. Pair-wise meta-analysis showed that after a weighted average of 23 months these novel anticoagulants lead to significant reductions in the risk of stroke/systemic embolism (odds ratio=0.81 [0.71-0.92], I2=23%) and all cause death (odds ratio=0.88 [0.82-0.95], I2=0%) in comparison to warfarin. Network meta-analysis showed that apixaban and dabigatran proved similarly superior to warfarin in preventing stroke/systemic embolism (odds ratio=0.78 [0.62-0.96] for apixaban vs warfarin; odds ratio=0.66 [0.52-0.84] for high-dose dabigatran vs warfarin; odds ratio for apixaban vs high-dose dabigatran=1.17 [0.85-1.63]), but apixaban was associated with fewer major bleedings (odds ratio=0.73 [0.57-0.93]) and drug discontinuations (odds ratio=0.64 [0.52-0.78]) than dabigatran. Rivaroxaban did not reduce stroke/systemic embolism (odds ratio=0.87 [0.71-1.07]) or major bleedings in comparison to warfarin (odds ratio=0.87 [0.71-1.07]) and was associated with more major bleedings in comparison to apixaban (odds ratio=1.52 [1.19-1.92]). Data for edoxaban were inconclusive. CONCLUSIONS: Novel oral anticoagulants appear as a very promising treatment option for atrial fibrillation. |
| Document Type: |
article in journal/newspaper |
| File Description: |
ELETTRONICO |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/23734288; volume:5; issue:1; firstpage:40; lastpage:54; numberofpages:15; journal:HSR PROCEEDINGS IN INTENSIVE CARE & CARDIOVASCULAR ANESTHESIA; http://hdl.handle.net/2318/135158; http://www.hsrproceedings.org/ |
| Availability: |
http://hdl.handle.net/2318/135158; http://www.hsrproceedings.org/ |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.A35C986C |
| Database: |
BASE |