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.

Coleman, C. I., Briere, J.-B., Fauchier, L., Levy, P., Bowrin, K., Toumi, M., Millier, A., Taieb, V. and Wu, O. (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. Journal of Market Access and Health Policy, 7(1), 1574541. (doi: 10.1080/20016689.2019.1574541) (PMID:30774786) (PMCID:PMC6366429)

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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.

Item Type:Articles
Additional Information:This work was supported by Bayer AG.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wu, Professor Olivia
Authors: Coleman, C. I., Briere, J.-B., Fauchier, L., Levy, P., Bowrin, K., Toumi, M., Millier, A., Taieb, V., 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:Journal of Market Access and Health Policy
Publisher:Taylor & Francis
ISSN:2001-6689
ISSN (Online):2001-6689
Published Online:04 February 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Journal of Market Access and Health Policy 7(1):1574541
Publisher Policy:Reproduced under a Creative Commons License

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