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
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 we...
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MDPI AG
2019-01-01
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| Series: | Journal of Market Access & Health Policy |
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| Online Access: | http://dx.doi.org/10.1080/20016689.2019.1574541 |
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| author | Craig I. Coleman Jean-Baptiste Briere Laurent Fauchier Pierre Levy Kevin Bowrin Mondher Toumi Aurélie Millier Vanessa Taieb Olivia Wu |
| author_facet | Craig I. Coleman Jean-Baptiste Briere Laurent Fauchier Pierre Levy Kevin Bowrin Mondher Toumi Aurélie Millier Vanessa Taieb Olivia Wu |
| author_sort | Craig I. Coleman |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-2a8f043b0a824dbaa571cb468c552b94 |
| institution | DOAJ |
| issn | 2001-6689 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | MDPI AG |
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| series | Journal of Market Access & Health Policy |
| spelling | doaj-art-2a8f043b0a824dbaa571cb468c552b942025-08-20T03:17:36ZengMDPI AGJournal of Market Access & Health Policy2001-66892019-01-017110.1080/20016689.2019.15745411574541Meta-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 fibrillationCraig I. Coleman0Jean-Baptiste Briere1Laurent Fauchier2Pierre Levy3Kevin Bowrin4Mondher Toumi5Aurélie Millier6Vanessa Taieb7Olivia Wu8University of ConnecticutBayer AGCentre Hospitalier Universitaire Trousseau et Université François RabelaisUniversité Paris-Dauphine, PSL Research UniversityBayer PlcUniversity of Aix-MarseilleCreativ-CeuticalCreativ-CeuticalUniversity of GlasgowIntroduction: 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.http://dx.doi.org/10.1080/20016689.2019.1574541anticoagulationnon-valvular atrial fibrillationnon-vitamin k antagonist oral anticoagulantsreal-world evidencestroke preventionmeta-analysis |
| spellingShingle | Craig I. Coleman Jean-Baptiste Briere Laurent Fauchier Pierre Levy Kevin Bowrin Mondher Toumi Aurélie Millier Vanessa Taieb Olivia Wu 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 Journal of Market Access & Health Policy anticoagulation non-valvular atrial fibrillation non-vitamin k antagonist oral anticoagulants real-world evidence stroke prevention meta-analysis |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | anticoagulation non-valvular atrial fibrillation non-vitamin k antagonist oral anticoagulants real-world evidence stroke prevention meta-analysis |
| url | http://dx.doi.org/10.1080/20016689.2019.1574541 |
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