AIMS: To analyse the safety and efficacy of direct oral anticoagulants (DOACs) in real-world studies including atrial fibrillation (AF) patients.METHODS AND RESULTS: Systematic review and meta-analysis of observational studies including AF patients on DOACs. Primary endpoints: any, major, gastrointestinal (GI), intracranial (ICH) and haemorrhagic stroke (HS). Secondary endpoints: ischaemic stroke (IS), Systemic embolism (SE), myocardial infarction (MI) and all-cause of death. A set of pair-wise meta-analyses using a random effect model and a random effect network meta-analysis under a Bayesian framework were performed. Prospero registration number: CRD42019137111. We included 21 studies with 605,771AF patients. Apixaban was associated with lower major and GI bleeding compared with Rivaroxaban (HR 2.0, 95% CI 1.6-2.5) and Dabigatran (HR 1.6, 95% CI 1.3-2.1). The latter drug performed better than Rivaroxaban (HR 1.2, 95% CI 1.0-1.5). Dabigatran and Apixaban had a similar association with HS, but Apixaban performed better than Rivaroxaban (HR 1.8, 95%CI 1.1-3.0). Apixaban had a similar association with Rivaroxaban and Dabigatran for ICH, the latter drug performing better than Rivaroxaban (HR 1.3, 95%CI 1.0-1.7). Rankograms showed that Apixaban was likely to be the first-choice treatment in relation to any (65%) major (100%) and GI bleeding (100%) followed by Dabigatran (46%, 100%, 99%, respectively). Dabigatran and Apixaban had similar rank as first choice for ICH (44% and 55%) and HS (52% and 48%). DOACs showed similar association with IS/SE, MI, all-cause of death.CONCLUSIONS: Analysis of real-world studies shows significant differences for safety among DOACs.

Real-world safety and efficacy of direct oral anticoagulants in atrial fibrillation. a network metanalysis on 605,771 patients / Menichelli, Danilo; Del Sole, Francesco; Di Rocco, Arianna; Farcomeni, Alessio; Vestri, Anna Rita; Violi, Francesco; Pignatelli, Pasquale; Yh Lip, Gregory; Pastori, Daniele. - In: EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY. - ISSN 2055-6837. - 7:FI1(2021), pp. f11-f19. [10.1093/ehjcvp/pvab002]

Real-world safety and efficacy of direct oral anticoagulants in atrial fibrillation. a network metanalysis on 605,771 patients

Menichelli, Danilo;Del Sole, Francesco;Di Rocco, Arianna;Farcomeni, Alessio;Vestri, Anna Rita;Violi, Francesco;Pignatelli, Pasquale;Pastori, Daniele
2021

Abstract

AIMS: To analyse the safety and efficacy of direct oral anticoagulants (DOACs) in real-world studies including atrial fibrillation (AF) patients.METHODS AND RESULTS: Systematic review and meta-analysis of observational studies including AF patients on DOACs. Primary endpoints: any, major, gastrointestinal (GI), intracranial (ICH) and haemorrhagic stroke (HS). Secondary endpoints: ischaemic stroke (IS), Systemic embolism (SE), myocardial infarction (MI) and all-cause of death. A set of pair-wise meta-analyses using a random effect model and a random effect network meta-analysis under a Bayesian framework were performed. Prospero registration number: CRD42019137111. We included 21 studies with 605,771AF patients. Apixaban was associated with lower major and GI bleeding compared with Rivaroxaban (HR 2.0, 95% CI 1.6-2.5) and Dabigatran (HR 1.6, 95% CI 1.3-2.1). The latter drug performed better than Rivaroxaban (HR 1.2, 95% CI 1.0-1.5). Dabigatran and Apixaban had a similar association with HS, but Apixaban performed better than Rivaroxaban (HR 1.8, 95%CI 1.1-3.0). Apixaban had a similar association with Rivaroxaban and Dabigatran for ICH, the latter drug performing better than Rivaroxaban (HR 1.3, 95%CI 1.0-1.7). Rankograms showed that Apixaban was likely to be the first-choice treatment in relation to any (65%) major (100%) and GI bleeding (100%) followed by Dabigatran (46%, 100%, 99%, respectively). Dabigatran and Apixaban had similar rank as first choice for ICH (44% and 55%) and HS (52% and 48%). DOACs showed similar association with IS/SE, MI, all-cause of death.CONCLUSIONS: Analysis of real-world studies shows significant differences for safety among DOACs.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1517892
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