Risk of myocardial infarction in patients with atrial fibrillation using vitamin K antagonists, aspirin or direct acting oral anticoagulants

Abstract

There is a twofold increase in the risk of AMI for users of DOACs, in comparison with VKAs, in AF therapy. In addition, the results suggested that in patients with AF, the incidence of AMI is higher during aspirin monotherapy than during the use of VKAs.

Real‐world complexity of atrial fibrillation treatment with oral anticoagulants: design and interpretation of pharmacoepidemiological studies

“…Comparing the paper's results with those in the literature, the findings appear surprising, in terms of both direction and magnitude. However, when we update previous evidence ( Figure 1A) with the results of Stolk and colleagues [13], this does not change the pooled effects ( Figure 1B). New findings should always be placed into the context of prior evidence while taking due account of the limitations of old and new data.…”

“…Technically, frequentist NMA under the random‐effects model combined randomized and nonrandomized studies by the design‐adjusted analysis with doubled standard errors ; the result of Stolk et al . was applied to both DOACs but weighted according to their relative prescription frequencies . CI, confidence interval; d.f., degrees of freedom; HR, hazard ratio; MI, myocardial infarction; Q, overall heterogeneity/inconsistency statistic…”

“…Network plots [29] from network meta-analysis (NMA) with external evidence [2][3][4][5][6][7][8][9][10][11] alone (A) and upon inclusion of the results of Stolk and colleagues (B) [13]. Based on cited literature [13] and reviews [30,31], we included covariate-adjusted studies with the direct-acting oral anticoagulants (DOACs) dabigatran and rivaroxaban for atrial fibrillation (AF) treatment (higher doses, if applicable). Technically, frequentist NMA [32] under the random-effects model combined randomized and nonrandomized studies by the design-adjusted analysis with doubled standard errors [33]; the result of Stolk et al was applied to both DOACs but weighted according to their relative prescription frequencies [13].…”

“…Based on cited literature [13] and reviews [30,31], we included covariate-adjusted studies with the direct-acting oral anticoagulants (DOACs) dabigatran and rivaroxaban for atrial fibrillation (AF) treatment (higher doses, if applicable). Technically, frequentist NMA [32] under the random-effects model combined randomized and nonrandomized studies by the design-adjusted analysis with doubled standard errors [33]; the result of Stolk et al was applied to both DOACs but weighted according to their relative prescription frequencies [13]. CI, confidence interval; d.f., degrees of freedom; HR, hazard ratio; MI, myocardial infarction; Q, overall heterogeneity/inconsistency statistic Third, the time scale for exposure-outcome relationships is a critical issue in pharmacoepidemiological research.…”

“…Our network metaanalysis of current evidence, shown in Figure 1A, demonstrated no increased risk of MI for these DOACs compared with warfarin. Using the Clinical Practice Research Datalink (CPRD, www.cprd.com), Stolk and colleagues also addressed this research question and suggested a twofold increase in the risk of MI for dabigatran and rivaroxaban compared with VKA [13]. We read their paper with interest, as their analytical procedures and the conclusions they reached deviated from those of previous observational studies [5][6][7][8][9][10][11][12].…”