Atrial fibrillation: direct Oral anticoagulants for preventing stroke and embolism
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2011 Sep 15;365(11):981-92 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral factor Xa inhibitors, apixaban, 5 mg twice daily
As Treatment, Chronic
Is better Than
warfarin
To reduce stroke or systemic embolism at 1.8 years (1.3% apixaban VS 1.6% warfarin) witout increasing major bleeding (2.1% apixaban VS 3.1% warfarin). Quite similar rate of all-cause death (3.5% apixaban VS 3.9% warfarin)
N Engl J Med. 2011 Sep 8;365(10):883-91. Epub 2011 Aug 10 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban, 20 mg once daily
As Treatment, Chronic
Is equal Than
dose-adjusted warfarin
To reduce stroke or systemic embolism (2.1% per year rivaroxaban VS 2.4% warfarin), or cause clinically relevant bleeding, major or nonmajor (15% per year both)
Circulation. 2011 May 31;123(21):2363-72 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, anticoagulants, oral direct thrombin inhibitors, risk of bleeding, elder patients The Use of
oral direct thrombin inhibitors, dabigatran, 110 or 150 mg twice daily fixed dose
As Treatment, Chronic
Is equal Than
warfarin
To risk of major bleeding, in patients >75 years, with the 110mg dose (4.43% dabigatran VS 4.37% warfarin) but a trend to more bleedings with 150mg dose (5.1% dabigatran versus 4.4% warfarin). Both doses had less bleedings in <75 years old
Am J Cardiol. 2012 Aug 1;110(3):453-60. Epub 2012 Apr 24 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To decrease risk for all-cause stroke and systemic embolism (RR 0.78) and all-cause mortality (RR 0.88), while reducing risk of intracranial bleeding (RR 0.88) but not of all major bleeding
J Am Coll Cardiol. 2012 Aug 21;60(8):738-46. Epub 2012 May 9 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is equal Than
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
To modify the risk of stroke and systemic embolism (no significant differences between drugs). Apixaban seemed to have less major bleedings than dabigatran 150mg or rivaroxaban (RR 0.74 and 0.66)
Canadian Agency for Drugs and Technologies in Health - CADTH. 2013 Mar: 1(1B); 1-142 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, antiplatelet drugs, aspirin, clopidogrel
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin, aspirin
To modify stroke, embolism or bleedings : there are some differences in some cases but with little absolute risk reduction
Lancet. 2014 Mar 15;383(9921):955-62 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To reduce reduced stroke or embolic events (RR 0.81), mainly driven by a reduction in haemorrhagic stroke (RR 0.49). New oral anticoagulants also reduced all-cause mortality (RR 0.90) but increased gastrointestinal bleeding (RR 1.25)
N Engl J Med. 2009 Sep 17;361(12):1139-51. Epub 2009 Aug 30 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
oral direct thrombin inhibitors, dabigatran, 110 or 150 mg twice daily fixed dose
As Treatment, Chronic
Is better Than
warfarin, INR adjusted dose
To reduce at 2 years ischemic strokes (1.53% - 1.11% per year 110 - 150 mg dabigatran VS 1.69% warfarin), with similar major bleedings (2.71% - 3.36% per year) and less haemorrhagic strokes (0.10% per year dabigatran VS 0.38% warfarin)
Circulation. 2014 Jul 8;130(2):138-46 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, older patients The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban
As Treatment, Chronic
Is equal Than
vitamine K antagonists, warfarin
To modify, in patients > 75 years, stroke (2.29% rivaroxaban VS 2.85% warfarin per 100 patient-years) or major bleeding (4.86% rivaroxaban versus 4.40% warfarin per 100 patient-years). Older patients had more strokes and major bleedings than young ones
N Engl J Med. 2011 Mar 3;364(9):806-17. Epub 2011 Feb 10 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, patients not suitable for vitamine K antagonists, warfarin The Use of
anticoagulants, oral factor Xa inhibitors, apixaban
As Treatment, Chronic
Is better Than
aspirin
To reduce stroke or systemic embolism (1.6% per year apixaban VS 3.7% aspirin) while not increasing major bleeding (1.4% per year apixaban VS 1.2% aspirin)
Ann Intern Med. 2012 Dec 4;157(11):796-807 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, thromboembolic disease The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To reduce mortality in atrial fibrillation (RR 0.88) but not in venous thromboembolism. Fatal bleeding was reduced (RR 0.60) but not major bleeding and bleeding risk may be increased in older people
J Am Geriatr Soc. 2014 May;62(5):857-64 Meta-Analysis
IN atrial fibrillation, thromboembolic disease, old patients, anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
warfarin
To prevent stroke or VTE recurrence: no numbers given in abstract
N Engl J Med. 2012 Apr 5;366(14):1287-97 Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, pulmonary embolism The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban, 15 mg twice daily for 3 weeks, followed by 20 mg once daily
As Treatment, Acute
Is equal Than
acute heparins LMWH (enoxaparin) followed by a vitamin K antagonist
To reduce recurrence of thromboembolic events at 6 -12 months (2,1% rivarox VS 2,8% warfarin) while not increasing clinically significant bleeding (10% rivarox VS 11% warfarin)