Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis
Autor: | Kai Wang, Bo Wang, Junnan Tang, Deliang Shen, Jian-Chao Zhang, Mengsen Bu, Jinying Zhang, Xiaolin Cui, Yan Bai, Jiacheng Guo |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
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 |
Zdroj: | BMC Cardiovascular Disorders, Vol 19, Iss 1, Pp 1-12 (2019) BMC Cardiovascular Disorders |
ISSN: | 1471-2261 |
Popis: | 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. |
Databáze: | OpenAIRE |
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