Liviu Klein, MD, MS
In patients with atrial fibrillation (AF), are new
oral anticoagulants effective and safe for preventing stroke and systemic
embolism compared with warfarin?
Included studies compared a new, non–vitamin
K antagonist oral anticoagulant with warfarin in patients with AF, had
> 1 year follow-up, and were published in peer-reviewed journals.
Studies of ximelagatran were excluded. Primary efficacy outcome was a composite
of stroke (including hemorrhagic stroke) and systemic embolism; secondary
efficacy outcomes were ischemic and unidentified stroke, hemorrhagic stroke,
all-cause mortality, vascular mortality, and myocardial infarction. Primary
safety outcome was major bleeding; secondary safety outcomes were
gastrointestinal bleeding and intracranial bleeding.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Library,
Science Citation Index Expanded, and ProQuest's Dissertations and Theses
database (all to Jul 2011); clinical trials databases; reviews; and reference
lists were searched for randomized controlled trials (RCTs). 3 noninferiority
RCTs met the selection criteria (
n = 44 563, mean age 70 to 73 y, 60%
to 65% men, median follow-up 657 to 730 d). ARISTOTLE (
n = 18 201) assessed apixaban, RE-LY (
n = 18 113) assessed dabigatran, and
n = 14 264) assessed rivaroxaban.
The main results of the meta-analyses are in the
In patients with atrial fibrillation, new oral
anticoagulants (apixaban, dabigatran, and rivaroxaban) reduced a composite of
stroke and systemic embolism, ischemic or unspecified stroke, hemorrhagic
stroke, all-cause mortality, vascular mortality, and intracranial bleeding
compared with warfarin.
New oral anticoagulants (NOAs) (apixaban,
dabigatran, or rivaroxaban) vs warfarin (war) in atrial fibrillation*
*Abbreviations defined in
Glossary. RRR, RRI,
NNT, NNH, and CI calculated from risk ratios and control event rates in article
using a random-effects model.
Liviu Klein. Review: New oral anticoagulants reduced stroke and
systemic embolism compared with warfarin in AF. Ann Intern Med. 2012;157:JC3–2. doi: 10.7326/0003-4819-157-6-201209180-02002
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Published: Ann Intern Med. 2012;157(6):JC3-2.
Cardiology, Neurology, Rhythm Disorders and Devices, Stroke, Venous Thromboembolism.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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