Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐Analysis
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 de...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-05-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.003206 |
| _version_ | 1818393449932521472 |
|---|---|
| author | Larisa G. Tereshchenko Charles A. Henrikson Joaquin Cigarroa Jonathan S. Steinberg |
| author_facet | Larisa G. Tereshchenko Charles A. Henrikson Joaquin Cigarroa Jonathan S. Steinberg |
| author_sort | Larisa G. Tereshchenko |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T05:45:30Z |
| format | Article |
| id | doaj.art-14814805d45148e7b39d12625317114d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T05:45:30Z |
| publishDate | 2016-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-14814805d45148e7b39d12625317114d2022-12-21T23:14:53ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-05-015510.1161/JAHA.116.003206Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐AnalysisLarisa G. Tereshchenko0Charles A. Henrikson1Joaquin Cigarroa2Jonathan S. Steinberg3Knight Cardiovascular Institute, Oregon Health & Science University, Portland, ORKnight Cardiovascular Institute, Oregon Health & Science University, Portland, ORKnight Cardiovascular Institute, Oregon Health & Science University, Portland, ORUniversity of Rochester School of Medicine & Dentistry and The Arrhythmia Institute of The Valley Health System, New York, NYBackgroundThe 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.https://www.ahajournals.org/doi/10.1161/JAHA.116.003206anticoagulationatrial fibrillationcomparative effectivenessleft atrial appendagenonvalvularoral anticoagulants |
| spellingShingle | Larisa G. Tereshchenko Charles A. Henrikson Joaquin Cigarroa Jonathan S. Steinberg Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anticoagulation atrial fibrillation comparative effectiveness left atrial appendage nonvalvular oral anticoagulants |
| title | Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐Analysis |
| title_full | Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐Analysis |
| title_fullStr | Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐Analysis |
| title_full_unstemmed | Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐Analysis |
| title_short | Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta‐Analysis |
| title_sort | comparative effectiveness of interventions for stroke prevention in atrial fibrillation a network meta analysis |
| topic | anticoagulation atrial fibrillation comparative effectiveness left atrial appendage nonvalvular oral anticoagulants |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.003206 |
| work_keys_str_mv | AT larisagtereshchenko comparativeeffectivenessofinterventionsforstrokepreventioninatrialfibrillationanetworkmetaanalysis AT charlesahenrikson comparativeeffectivenessofinterventionsforstrokepreventioninatrialfibrillationanetworkmetaanalysis AT joaquincigarroa comparativeeffectivenessofinterventionsforstrokepreventioninatrialfibrillationanetworkmetaanalysis AT jonathanssteinberg comparativeeffectivenessofinterventionsforstrokepreventioninatrialfibrillationanetworkmetaanalysis |