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Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis
- Source :
- BMC Cardiovascular Disorders, Vol 19, Iss 1, Pp 1-12 (2019), BMC Cardiovascular Disorders
- Publication Year :
- 2019
- Publisher :
- BMC, 2019.
-
Abstract
- Background The development of novel oral anticoagulants (NOACs) has changed the landscape of non-valvular atrial fibrillation (NVAF) management. In this study, the effectiveness and the safety of several NOACs were evaluated in a real-world setting among Asian patients with NVAF. Methods The literature search was conducted crossing different databases including Embase, MEDLINE, and the Cochrane Library from inception through March 1, 2019, for studies which included real-world perspectives comparing the individual NOACs with each other or with warfarin among Asians with NVAF. The primary outcomes were defined as stroke or systemic embolism (SSE) and major bleeding; ischemic stroke, all-cause death as well as intracranial bleeding were classified as the secondary outcomes. Results From sixteen real-world studies, a total of 312,827 Asian patients were included in this analysis. In comparison with warfarin, the utilization of apixaban, dabigatran, and rivaroxaban significantly lowered the risk of major bleeding (apixaban: HR 0.47, 95%CI 0.35–0.63; dabigatran: HR 0.59, 95%CI 0.47–0.73; rivaroxaban: HR 0.66, 95%CI 0.52–0.83) and lessened the all-cause death rate (apixaban: HR 0.29, 95%CI 0.16–0.52; dabigatran: HR 0.40, 95%CI 0.27–0.60; rivaroxaban: HR 0.42, 95%CI 0.28–0.65). Apixaban (HR 0.59; 95%CI 0.40–0.85) reduced the possibility of ischemic stroke when compared against dabigatran. Rivaroxaban showed a higher chance of causing an ischemic stroke (HR 1.61; 95%CI 1.08–2.41) and major bleeding (HR 1.39; 95%CI 1.02–1.90) than Apixaban. Conclusions Apixaban, dabigatran and rivaroxaban were more effective than warfarin on reducing the risks of stroke and haemorrhage; meanwhile, apixaban was likely to lower the risk of major bleeding comparing to rivaroxaban. Trial registration PROSPERO registry number: CRD42018086914. Electronic supplementary material The online version of this article (10.1186/s12872-019-1165-5) contains supplementary material, which is available to authorized users.
- Subjects :
- medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Administration, Oral
Hemorrhage
030204 cardiovascular system & hematology
Cochrane Library
Non-valvular atrial fibrillation
Risk Assessment
Dabigatran
03 medical and health sciences
0302 clinical medicine
Asian People
Risk Factors
Internal medicine
Atrial Fibrillation
medicine
Humans
030212 general & internal medicine
Network meta-analysis
Stroke
Rivaroxaban
business.industry
Warfarin
Anticoagulants
Atrial fibrillation
Novel Oral anticoagulants
medicine.disease
Treatment Outcome
lcsh:RC666-701
Meta-analysis
Apixaban
Asian patients
Cardiology and Cardiovascular Medicine
business
medicine.drug
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14712261
- Volume :
- 19
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Cardiovascular Disorders
- Accession number :
- edsair.doi.dedup.....6054abc6064202e602317c69e79b3539