Real-world Evidence Comparing Oral Anticoagulants in non-valvular Atrial Fibrillation: A Systematic Review and Network meta-analysis
Steven Deitelzweig, Evelien Bergrath, Manuela Di Fusco, Amiee Kang, Mirko Savone, Joseph C. Cappelleri, Cristina Russ, Marissa Betts, Allie Cichewicz, Kassandra Schaible, Jialu Tarpey, Kyle Fahrbach
Abstract
Aim: To compare real-world effectiveness/safety of non-vitamin K antagonist oral anticoagulants and vitamin K antagonists among patients with non-valvular atrial fibrillation. Materials & methods: A systematic review of electronic databases yielded 7661 citations published from January 2013 to January 2020. Fifty-five studies were included in Bayesian network meta-analyses of hazard ratios. Results & conclusion: In comparison with vitamin K antagonists, apixaban, dabigatran and rivaroxaban were associated with a reduced risk of stroke or systemic embolism, ischemic stroke, intracranial hemorrhage and all-cause mortality. Apixaban, dabigatran and edoxaban, but not rivaroxaban, were associated with a reduced risk of major bleeding. This study confirmed the effectiveness and safety of non-vitamin K antagonist oral anticoagulants for the treatment of non-valvular atrial fibrillation in real-world settings, consistent with clinical trial evidence.