| Summary: | BackgroundThe goal of this study was to compare the safety and effectiveness of individual antiembolic interventions in nonvalvular atrial fibrillation (AF): novel oral anticoagulants (NOACs) (apixaban, dabigatran, edoxaban, and rivaroxaban); vitamin K antagonists (VKA); aspirin; and the Watchman device. Methods and ResultsA network meta‐analysis of randomized, clinical trials (RCTs) was performed. RCTs that included patients with prosthetic cardiac valves or mitral stenosis, mean or median follow‐up <6 months, <200 participants, without published report in English language, and NOAC phase II studies were excluded. The placebo/control arm received either placebo or no treatment. The primary efficacy outcome was the combination of stroke (of any type) and systemic embolism. All‐cause mortality served as a secondary efficacy outcome. The primary safety outcome was the combination of major extracranial bleeding and intracranial hemorrhage. A total of 21 RCTs (96 017 nonvalvular AF patients; median age, 72 years; 65% males; median follow‐up, 1.7 years) were included. In comparison to placebo/control, use of aspirin (odds ratio [OR], 0.75 [95% CI, 0.60–0.95]), VKA (0.38 [0.29–0.49]), apixaban (0.31 [0.22–0.45]), dabigatran (0.29 [0.20–0.43]), edoxaban (0.38 [0.26–0.54]), rivaroxaban (0.27 [0.18–0.42]), and the Watchman device (0.36 [0.16–0.80]) significantly reduced the risk of any stroke or systemic embolism in nonvalvular AF patients, as well as all‐cause mortality (aspirin: OR, 0.82 [0.68–0.99]; VKA: 0.69 [0.57–0.85]; apixaban: 0.62 [0.50–0.78]; dabigatran: 0.62 [0.50–0.78]; edoxaban: 0.62 [0.50–0.77]; rivaroxaban: 0.58 [0.44–0.77]; and the Watchman device: 0.47 [0.25–0.88]). Apixaban (0.89 [0.80–0.99]), dabigatran (0.90 [0.82–0.99]), and edoxaban (0.89 [0.82–0.96]) reduced risk of all‐cause death as compared to VKA. ConclusionsThe entire spectrum of therapy to prevent thromboembolism in nonvalvular AF significantly reduced stroke/systemic embolism events and mortality.
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