Meta-analysis of efficacy and safety of new oral anticoagulants in atrial fibrillation therapy
- Author:
Xiu-Bo SUN
1
Author Information
- Publication Type:Journal Article
- Keywords: Atrial fibrillation; Efficacy; Meta-analysis; New oral anticoagulant; Safety; Warfarin
- From: Chinese Pharmaceutical Journal 2016;51(5):417-424
- CountryChina
- Language:Chinese
- Abstract: OBJECTIVE: To evaluate the efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) in the treatment of atrial fibrillation. METHODS: The randomized controlled trials of new oral anticoagulants versus warfarin in the treatment of atrial fibrillation, which had been published from the time of library foundation to May, 2015, were collected from Pubmed, Embase, Medline, Cochrane, ClinicalTrials.gov, CNKI, Wanfang database, and VIP database according to the inclusion criterias. At the same time the quality of the trials was evaluated and the results of studies were analyzed using RevMan 5.3 software and Stata 13.1 software. RESULTS: Eleven randomized controlled trials were included, involving 75 621 patients. Meta-analysis showed that compared with warfarin, the new oral anticoagulants significantly reduced the incidences of all-cause mortality [RR=0.90, 95% CI(0.85, 0.94), P<0.000 1], stroke and systemic embolism [RR=0.86, 95% CI(0.79, 0.93), P=0.0001], major bleeding [RR=0.79, 95% CI(0.74, 0.84), P<0.00001], and intracranial bleeding [RR=0.43, 95% CI(0.37, 0.51), P<0.000 01]. No differences were found in the incidence of ischemic stroke [RR=1.02, 95% CI (0.93, 1.12), P=0.71] and myocardial infarction [RR=1.02, 95% CI (0.91, 1.16), P=0.70]. Heterogeneity was lower through subgroup analysis, no publication bias was found in funnel plots of most outcomes, and sensitivity analysis indicated the results were reliable. CONCLUSION The efficacy and safety of new oral anticoagulants are better than warfarin, which may have broad prospects.
