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)

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 > School of Health & 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