Real-world clinical evidence on rivaroxaban, dabigatran, and apixaban compared with vitamin K antagonists in patients with non-valvular atrial fibrillation: a systematic literature review

Briere, J.-B., Bowrin, K., Coleman, C., Fauchier, L., Levy, P., Folkerts, K., Toumi, M., Taieb, V., Millier, A. and Wu, O. (2019) Real-world clinical evidence on rivaroxaban, dabigatran, and apixaban compared with vitamin K antagonists in patients with non-valvular atrial fibrillation: a systematic literature review. Expert Review of Pharmacoeconomics and Outcomes Research, 19(19), pp. 27-36. (doi: 10.1080/14737167.2018.1518134) (PMID:30169975)

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Abstract

Introduction Several comparative real-world effectiveness studies on direct oral anticoagulants (DOACs) have been conducted, but an overview of the available evidence remains to be developed, which could provide a better understanding of the value of DOACs relative to vitamin K antagonists (VKAs). Areas covered A systematic literature review was conducted on the available real-world evidence (RWE) of three DOACs (rivaroxaban, dabigatran, and apixaban) compared with VKAs (e.g. warfarin), in patients with non-valvular atrial fibrillation (NVAF). This systematic literature review included RWE published up to December 2016. Studies with >50 patients reporting on incident and prevalent NVAF cases were included. The following databases were searched: Medline, Embase, and the Cochrane Library. Outcomes of interest included thromboembolic events, all-cause mortality, bleeding events, and non-persistence. Of the 562 RWE DOACs articles retrieved, 49 presented results for rivaroxaban versus VKAs, 79 for dabigatran versus VKAs, and 18 for apixaban versus VKAs. Substantial heterogeneity was found across patient population, outcome definition, and follow-up period. Major bleeding, ischemic stroke, and intracranial hemorrhage were the most frequent outcomes analyzed. Expert commentary Overall, the RWE studies were aligned with the Phase 3 trials. However, conflicting results were reported for several outcomes of interest.

Item Type:Articles
Additional Information:Published erratum: Expert Review of Pharmacoeconomics & Outcomes Research [20 Jun 2019, 19(4):503]: https://www.tandfonline.com/doi/full/10.1080/14737167.2019.1633768
Keywords:Anticoagulation, direct oral anticoagulants, non-valvular atrial fibrillation, real-world evidence, stroke prevention.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wu, Professor Olivia
Authors: Briere, J.-B., Bowrin, K., Coleman, C., Fauchier, L., Levy, P., Folkerts, K., Toumi, M., Taieb, V., Millier, A., and Wu, O.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:Expert Review of Pharmacoeconomics and Outcomes Research
Publisher:Taylor & Francis
ISSN:1473-7167
ISSN (Online):1744-8379
Published Online:19 September 2018

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