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. 2019 Feb 4;7(1):1574541.
doi: 10.1080/20016689.2019.1574541. eCollection 2019.

Meta-analysis of real-world evidence comparing non-vitamin K antagonist oral anticoagulants with vitamin K antagonists for the treatment of patients with non-valvular atrial fibrillation

Craig I Coleman  1 , Jean-Baptiste Briere  2 , Laurent Fauchier  3 , Pierre Levy  4 , Kevin Bowrin  5 , Mondher Toumi  6 , Aurélie Millier  7 , Vanessa Taieb  8 , Olivia Wu  9
Affiliations

Meta-analysis of real-world evidence comparing non-vitamin K antagonist oral anticoagulants with vitamin K antagonists for the treatment of patients with non-valvular atrial fibrillation

Craig I Coleman et al. J Mark Access Health Policy. .

Abstract

Introduction: Numerous real-world studies have compared non-vitamin K antagonist oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF). A meta-analysis was performed to synthesize the available evidence. Methods: Systematic searches were performed through 12/2016 to identify non-randomized NVAF studies comparing NOACs with VKAs, and reporting effectiveness, safety, or persistence. Results: Of 562 citations identified, 49, 79, and 18 compared rivaroxaban, dabigatran, and apixaban, respectively, with VKAs and were included. Compared with VKAs, rivaroxaban was associated with a reduced risk of ischemic stroke (IS) (hazard ratio [HR] = 0.83, 95% confidence interval [CI] = 0.75-0.93), intracranial haemorrhage (ICH) (HR = 0.69, 95% CI = 0.52-0.90), and non-persistence (HR = 0.62, 95% CI = 0.60-0.65). Dabigatran was associated with a significantly lower risk of IS (HR = 0.80, 95% CI = 0.65-0.98) and ICH (HR = 0.45, 95% CI = 0.36-0.58), but not for non-persistence (HR = 0.91, 95% CI = 0.53-1.55), compared with VKAs. Apixaban was associated with a lower risk of ICH than VKAs (HR = 0.41, 95% CI = 0.28-0.60), but was not different to VKAs in terms of IS (HR = 1.01, 95% CI = 0.87-1.17) or non-persistence (HR = 1.08, 95% CI = 0.81-1.45). Conclusion: NOACs appear to be at least as effective and safe as VKAs for stroke prevention in patients with NVAF.

Keywords: Anticoagulation; meta-analysis; non-valvular atrial fibrillation; non-vitamin K antagonist oral anticoagulants; real-world evidence; stroke prevention.

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Figures

Figure 1.
Figure 1.
Meta-analysis results for rivaroxaban versus VKA.
Figure 2.
Figure 2.
Meta-analysis results for dabigatran versus VKA.
Figure 3.
Figure 3.
Meta-analysis results for apixaban versus VKA.
See this image and copyright information in PMC

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