Soheir S. Adam, MD; Thomas L. Ortel, MD, PHD; John W. Williams, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1317.
Adam S., Ortel T., Williams J.; Comparative Effectiveness of Warfarin and New Anticoagulants. Ann Intern Med. 2013;158:637-638. doi: 10.7326/0003-4819-158-8-201304160-00017
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Published: Ann Intern Med. 2013;158(8):637-638.
We appreciate the comments on our review, particularly about whether to pool across drugs, the key outcomes, and whether adherence can be monitored with laboratory testing. A critical issue for all meta-analyses is whether and how to pool results. We chose to pool results by condition for the primary outcomes, because outcomes are condition-specific, and across conditions for adverse effects common to these drug classes. Dabigatran and factor Xa inhibitors are all NOACs that have a similar mechanism of action because they each target a single enzyme in the coagulation cascade. Although we considered the study designs and drug mechanisms of action sufficiently similar for pooling, we acknowledged that important differences may exist between drugs and that our approach and the relatively small number of studies limit the ability to identify differences among or within drug classes.
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