Ontology highlight
ABSTRACT: Objective
To examine the comparative efficacy and safety of antithrombotic treatments (apixaban, dabigatran, edoxaban, rivaroxaban and vitamin K antagonists (VKA) at a standard adjusted dose (target international normalised ratio 2.0-3.0), acetylsalicylic acid (ASA), ASA and clopidogrel) for non-valvular atrial fibrillation and among subpopulations.Design
Systematic review and network meta-analysis.Data sources
A systematic literature search strategy was designed and carried out using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and the grey literature including the websites of regulatory agencies and health technology assessment organisations for trials published in English from 1988 to January 2014.Eligibility criteria for selecting studies
Randomised controlled trials were selected for inclusion if they were published in English, included at least one antithrombotic treatment and involved patients with non-valvular atrial fibrillation eligible to receive anticoagulant therapy.Results
For stroke or systemic embolism, dabigatran 150?mg and apixaban twice daily were associated with reductions relative to standard adjusted dose VKA, whereas low-dose ASA and the combination of clopidogrel plus low-dose ASA were associated with increases. Absolute risk reductions ranged from 6 fewer events per 1000 patients treated for dabigatran 150?mg twice daily to 15 more events for clopidogrel plus ASA. For major bleeding, edoxaban 30?mg daily, apixaban, edoxaban 60?mg daily and dabigatran 110?mg twice daily were associated with reductions compared to standard adjusted dose VKA. Absolute risk reductions with these agents ranged from 18 fewer per 1000 patients treated each year for edoxaban 30?mg daily to 24 more for medium dose ASA.Conclusions
Compared with standard adjusted dose VKA, new oral anticoagulants were associated with modest reductions in the absolute risk of stroke and major bleeding. People on antiplatelet drugs experienced more strokes compared with anticoagulant drugs without any reduction in bleeding risk. To fully elucidate the comparative benefits and harms of antithrombotic agents across the various subpopulations, rigorously conducted comparative studies or network meta-regression analyses of patient-level data are required.Systematic review registration number
PROSPERO registry-CRD42012002721.
SUBMITTER: Cameron C
PROVIDER: S-EPMC4054633 | biostudies-literature | 2014 Jun
REPOSITORIES: biostudies-literature
BMJ open 20140602 6
<h4>Objective</h4>To examine the comparative efficacy and safety of antithrombotic treatments (apixaban, dabigatran, edoxaban, rivaroxaban and vitamin K antagonists (VKA) at a standard adjusted dose (target international normalised ratio 2.0-3.0), acetylsalicylic acid (ASA), ASA and clopidogrel) for non-valvular atrial fibrillation and among subpopulations.<h4>Design</h4>Systematic review and network meta-analysis.<h4>Data sources</h4>A systematic literature search strategy was designed and carr ...[more]