Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups

Abstract

Background. New oral anticoagulants (NOAC; rivaroxaban, dabigatran, apixaban) have become available as an alternative to warfarin anticoagulation in non-valvular atrial fibrillation (NVAF). Methods. MEDLINE and CENTRAL, regulatory agencies websites, clinical trials registers and conference proceedings were searched to identify randomised controlled trials of NOAC versus warfarin in NVAF. Two investigators reviewed all studies and extracted data on patient and study characteristics along with cardiovascular outcomes. Relative risks (RR) and 95% confidence intervals (CI) were estimated using a random effect meta-analysis. Results. Three clinical trials in 50,578 patients were included. The risk of non-hemorrhagic stroke and systemic embolic events (SEE) was similar with the NOAC and warfarin (RR = 0.93; 95% CI = 0.83–1.04), while the risk of intracranial bleeding (ICB) with the NOAC was lower than with warfarin (RR = 0.46; 95% CI = 0.33–0.65). We found differences in the effect size on all strokes and SEE depending on geographic region as well as on non-hemorrhagic stroke, SEE, bleeding and mortality depending on time in therapeutic range. Conclusion. The NOAC seem no more effective than warfarin for prevention of nonhemorrhagic stroke and SEE in the overall NVAF population, but are generally associated with a lower risk of ICB than warfarin.

Use of Thromboelastography (TEG) for Detection of New Oral Anticoagulants

“…All of these agents, and others in development, are under investigation for the management of multiple thromboembolic disorders. [3][4][5][6][7][8][9][10] Dabigatran is an oral direct inhibitor of thrombin (factor IIa) that is ''not permanent,'' selective, and competitive. Rivaroxaban and apixaban are oral direct inhibitors of factor Xa and are also competitive, selective, and not permanent.…”

Management of acute intracerebral haemorrhage – an update

“…NOACs have been considered to have lower risk of recurrent sICH compared with VKA (relative risk of 0.46). 47 As for antiplatelet therapy, there is conflicting evidence to whether it increases the risk of recurrent sICH. Some studies concluded that antiplatelet therapy increased the risk of recurrent sICH while others did not.…”

Epidemiology and Management of Heart Failure Patients With Atrial Fibrillation

“…В крупных рандомизированных исследованиях по ХСН выявлено, что распространенность ФП возрастает парал-лельно утяжелению функционального класса ХСН от 10% у больных с I-II ФК по NYHA до 50% у пациентов с IV ФК [12,13]. С другой стороны, в исследованиях по ФП частота встречаемости ХСН варьирует от 21 до 68% [14]. Среди популяции больных Фрамингемского исследования почти у 1 500 лиц старше 50 лет за период наблюдения было отмечено развитие ХСН, ФП или ХСН в сочетании с ФП.…”