Meta-Analysis of Effectiveness and Safety of Oral Anticoagulants in Atrial Fibrillation With Focus on Apixaban

Abstract

We performed a meta-analysis of data on the effectiveness and safety of apixaban compared with other oral anticoagulants (warfarin or rivaroxaban or dabigatran or edoxaban) for stroke prevention in atrial fibrillation (AF) in different settings of randomized controlled trials, real-world studies, and radiofrequency ablation (RFA). Thirty studies were searched in PubMed, the Cochrane Library, and Clinicaltrials.gov databases reporting comparative effectiveness and safety of apixaban with warfarin (n = 23), rivaroxaban (n = 12), dabigatran (n = 13), or edoxaban (n = 2) for stroke prevention in AF. In real-world estimates, apixaban was similar to warfarin for the prevention of stroke or systematic thromboembolism (hazard ratio 0.93, 95% CI 0.71 to 1.14, I = 82.9%, N = 7), and safer than warfarin in the risks of major bleeding (hazard ratio 0.62, 95% CI 0.54 to 0.70, I = 18.7%, N = 9) in patients with AF. The risk of stroke or thromboembolism with apixaban was similar to rivaroxaban, dabigatran, and edoxaban in the settings of real-world studies and RFA. Major bleeding with apixaban was generally lower than rivaroxaban (relative risks 0.45, 95% CI 0.38 to 0.53, I = 0%, N = 5) and similar to dabigatran in real-world studies (relative risks 1.44, 95% CI 0.33 to 6.30, I = 97.7%, N = 5), but similar to rivaroxaban, dabigatran, and edoxaban in RFA. In conclusion, our meta-analysis provides a comprehensive estimate of the effectiveness and safety of apixaban compared with other oral anticoagulants (warfarin, rivaroxaban, dabigatran, and edoxaban) in patients with AF in different settings of randomized controlled trial, real-world studies, and RFA.

Use of Non‐Vitamin K Antagonist Oral Anticoagulants 2008–2016: A Danish Nationwide Cohort Study

“…Individuals receiving apixaban for AF had a higher percentage of previous bleeding, stroke and chronic heart failure. This might be explained by selective prescribing due to the low risk of bleeding with apixaban , especially in the elderly .…”

Antithrombotic Therapy for Atrial Fibrillation

“…lf VKA therapy is being considered, the SAMe-TT 2 R 2 score can be used to identify patients who are good candidates for this approach. be considerations in choosing an agent (Table 6) 124,127,128,[134][135][136]174,181,183,[192][193][194][195][196][197][198][199][200][201] for comparative information. The VKAs are still widely used and are an acceptable alternative with target TTR $ 70%.…”

Blæðingar frá meltingarvegi í íslensku og erlendu samhengi - yfirlitsgrein

“…Nýleg safngreining (meta-analysis) sem tók til sjúklinga með gáttatif, skoðaði apixaban sérstaklega í samanburði við kóvar og önnur nýrri blóðþynningarlyf. 45 Safngreiningin tók baeði til slembiraðaðra íhlutunarrannsókna (randomized controlled trials) þar sem meirihluti gagna er frá lyfjafyrirtaekjum, og gagna úr raunverulegum aðstaeðum. Niðurstöðurnar bentu til þess að apixaban sé að minnsta kosti jafn gott og önnur lyf til þess að draga úr líkum á blóðþurrðarslagi, auk þess að koma best út með tilliti til haettulegra aukaverkan, svo sem heilablaeðinga eða alvarlegra blaeðinga frá meltingarvegi.…”

“…Niðurstöðurnar bentu til þess að apixaban sé að minnsta kosti jafn gott og önnur lyf til þess að draga úr líkum á blóðþurrðarslagi, auk þess að koma best út með tilliti til haettulegra aukaverkan, svo sem heilablaeðinga eða alvarlegra blaeðinga frá meltingarvegi. 45 Helicobacter pylori Tilvist og skaðleg áhrif H. pylori á maga og skeifugörn hafa verið þekkt frá því snemma á níunda áratuginum. 46 smitist helst í gegnum saur/munn smit en einnig munn/munn smit.…”