Meta-Analysis of Effectiveness and Safety of Oral Anticoagulants in Atrial Fibrillation With Focus on Apixaban
Section snippets
Methods
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the reporting Meta-analyses of Observational Studies in Epidemiology when performing this meta-analysis.4, 5
A comprehensive search of PubMed, the Cochrane Library, and Clinicaltrials.gov databases was performed by 2 independent reviewers (YB and X-BS) using the following items: “atrial fibrillation” OR “AF” AND “apixaban” OR “rivaroxaban” OR “dabigatran” OR “edoxaban” OR “warfarin” OR “NOAC” OR “DOAC” AND
Results
A total of 1,936 studies were initially identified. After screening titles and abstracts, we excluded 1,863 papers, and 73 remained for detailed evaluation. Of these, 42 were excluded as they did not meet the inclusion criteria (7 reviews and meta-analysis; 7 papers without outcomes of OACs; 9 papers without separate information on apixaban, rivaroxaban, dabigatran, or edoxaban; 12 studies with duplicate data, 1 on the setting of direct current cardioversion; and 7 with mixed diseases except
Discussion
In this meta-analysis, our principal findings are as follows: (1) apixaban was associated with similar effectiveness of stroke or TE prevention compared with warfarin, dabigatran, rivaroxaban, and edoxaban in real-world studies, and RFA; (2) apixaban had similar safety to warfarin, rivaroxaban, dabigatran, and edoxaban for major bleeding in the setting of RFA, but was safer than warfarin in RCTs and real-world studies; (3) apixaban was safer than rivaroxaban in real-world studies, and had
Disclosures
C-SM has received honoraria from Bristol-Myers Squibb (BMS), Pfizer, Johnson & Johnson, Boehringer Ingelheim (BI), and Bayer for giving lectures.
GYHL has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche, and Daiichi-Sankyo.
Other authors declare no conflict of interest.
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Funding: This work was supported by grants from Beijing Tongren Hospital, Capital Medical University (2016-YJJ-BJRC-010), the National Natural Science Fund (81470464 and 81530016), and the Ministry of Science and Technology (2016YFC0900901).
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