Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation

Amy Tawfik,1,2 Joanna M Bielecki,2 Murray Krahn,1,2 Paul Dorian,3,4 Jeffrey S Hoch,1,3,5 Heather Boon,1 Don Husereau,6 Petros Pechlivanoglou2 1Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, 2Toronto Health Economics and Technology Assessment (THETA) Collaborative, University...

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Autores principales:	Tawfik A, Bielecki JM, Krahn M, Dorian P, Hoch JS, Boon H, Husereau D, Pechlivanoglou P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Meta-analysis Cerebrovascular disorders/drug therapy Stroke Prevention Platelet Aggregation Inhibitors Atrial fibrillation/prevention and control Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/37dc488464564ed0ad9548ea3c5ae7b6
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spelling	oai:doaj.org-article:37dc488464564ed0ad9548ea3c5ae7b62021-12-02T06:21:32ZSystematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation1179-1438https://doaj.org/article/37dc488464564ed0ad9548ea3c5ae7b62016-08-01T00:00:00Zhttps://www.dovepress.com/systematic-review-and-network-meta-analysis-of-stroke-prevention-treat-peer-reviewed-article-CPAAhttps://doaj.org/toc/1179-1438Amy Tawfik,1,2 Joanna M Bielecki,2 Murray Krahn,1,2 Paul Dorian,3,4 Jeffrey S Hoch,1,3,5 Heather Boon,1 Don Husereau,6 Petros Pechlivanoglou2 1Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, 2Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, 3Centre for Excellence in Economic Analysis Research (CLEAR), Li Ka Shing Knowledge Institute, St Michael’s Hospital, 4Department of Medicine and Cardiology, University of Toronto, 5Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, 6Institute of Health Economics, Edmonton, AB, Canada Background: In the last 4 years, four novel oral anticoagulants have been developed as alternatives to warfarin and antiplatelet agents for stroke prevention in atrial fibrillation (AF) patients. The objective of this review was to estimate the comparative effectiveness of all antithrombotic treatments for AF patients.Materials and methods: Data sources were Medline Ovid (1946 to October 2015), Embase Ovid (1980 to October 2015), and the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 9, 2015). Randomized controlled trials of AF patients were selected if they compared at least two of the following: placebo, aspirin, aspirin and clopidogrel combination therapy, adjusted-dose warfarin (target international normalized ratio 2.0–3.0), dabigatran, rivaroxaban, apixaban, and edoxaban. Bayesian network meta-analyses were conducted for outcomes of interest (all stroke, ischemic stroke, myocardial infarction, overall mortality, major bleeding, and intracranial hemorrhage).Results: Based on 16 randomized controlled trials of 96,826 patients, all oral anticoagulants were more effective than antiplatelet agents at reducing the risk of ischemic stroke and all strokes. Compared to warfarin, dabigatran 150 mg (rate ratio 0.65, 95% credible interval 0.52–0.82) and apixaban (rate ratio 0.82, 95% credible interval 0.69–0.97) reduced the risk of all strokes. Dabigatran 150 mg was also more effective than warfarin at reducing ischemic stroke risk (rate ratio 0.76, 95% credible interval 0.59–0.99). Aspirin, apixaban, dabigatran 110 mg, and edoxaban were associated with less major bleeding than warfarin.Conclusion: All oral anticoagulants reduce the risk of stroke in AF patients. Some novel oral anticoagulants are associated with a lower stroke and/or major bleeding risk than warfarin. In addition to the safety and effectiveness of drug therapy, as reported in this study, individual treatment recommendations should also consider the patient’s underlying stroke and bleeding risk profile. Keywords: meta-analysis, cerebrovascular disorders/drug therapy, stroke prevention, platelet-aggregation inhibitors, atrial fibrillation/prevention and controlTawfik ABielecki JMKrahn MDorian PHoch JSBoon HHusereau DPechlivanoglou PDove Medical PressarticleMeta-analysisCerebrovascular disorders/drug therapyStroke PreventionPlatelet Aggregation InhibitorsAtrial fibrillation/prevention and controlTherapeutics. PharmacologyRM1-950ENClinical Pharmacology: Advances and Applications, Vol 2016, Iss Issue 1, Pp 93-107 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Meta-analysis Cerebrovascular disorders/drug therapy Stroke Prevention Platelet Aggregation Inhibitors Atrial fibrillation/prevention and control Therapeutics. Pharmacology RM1-950
spellingShingle	Meta-analysis Cerebrovascular disorders/drug therapy Stroke Prevention Platelet Aggregation Inhibitors Atrial fibrillation/prevention and control Therapeutics. Pharmacology RM1-950 Tawfik A Bielecki JM Krahn M Dorian P Hoch JS Boon H Husereau D Pechlivanoglou P Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation
description	Amy Tawfik,1,2 Joanna M Bielecki,2 Murray Krahn,1,2 Paul Dorian,3,4 Jeffrey S Hoch,1,3,5 Heather Boon,1 Don Husereau,6 Petros Pechlivanoglou2 1Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, 2Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, 3Centre for Excellence in Economic Analysis Research (CLEAR), Li Ka Shing Knowledge Institute, St Michael’s Hospital, 4Department of Medicine and Cardiology, University of Toronto, 5Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, 6Institute of Health Economics, Edmonton, AB, Canada Background: In the last 4 years, four novel oral anticoagulants have been developed as alternatives to warfarin and antiplatelet agents for stroke prevention in atrial fibrillation (AF) patients. The objective of this review was to estimate the comparative effectiveness of all antithrombotic treatments for AF patients.Materials and methods: Data sources were Medline Ovid (1946 to October 2015), Embase Ovid (1980 to October 2015), and the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 9, 2015). Randomized controlled trials of AF patients were selected if they compared at least two of the following: placebo, aspirin, aspirin and clopidogrel combination therapy, adjusted-dose warfarin (target international normalized ratio 2.0–3.0), dabigatran, rivaroxaban, apixaban, and edoxaban. Bayesian network meta-analyses were conducted for outcomes of interest (all stroke, ischemic stroke, myocardial infarction, overall mortality, major bleeding, and intracranial hemorrhage).Results: Based on 16 randomized controlled trials of 96,826 patients, all oral anticoagulants were more effective than antiplatelet agents at reducing the risk of ischemic stroke and all strokes. Compared to warfarin, dabigatran 150 mg (rate ratio 0.65, 95% credible interval 0.52–0.82) and apixaban (rate ratio 0.82, 95% credible interval 0.69–0.97) reduced the risk of all strokes. Dabigatran 150 mg was also more effective than warfarin at reducing ischemic stroke risk (rate ratio 0.76, 95% credible interval 0.59–0.99). Aspirin, apixaban, dabigatran 110 mg, and edoxaban were associated with less major bleeding than warfarin.Conclusion: All oral anticoagulants reduce the risk of stroke in AF patients. Some novel oral anticoagulants are associated with a lower stroke and/or major bleeding risk than warfarin. In addition to the safety and effectiveness of drug therapy, as reported in this study, individual treatment recommendations should also consider the patient’s underlying stroke and bleeding risk profile. Keywords: meta-analysis, cerebrovascular disorders/drug therapy, stroke prevention, platelet-aggregation inhibitors, atrial fibrillation/prevention and control
format	article
author	Tawfik A Bielecki JM Krahn M Dorian P Hoch JS Boon H Husereau D Pechlivanoglou P
author_facet	Tawfik A Bielecki JM Krahn M Dorian P Hoch JS Boon H Husereau D Pechlivanoglou P
author_sort	Tawfik A
title	Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation
title_short	Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation
title_full	Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation
title_fullStr	Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation
title_full_unstemmed	Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation
title_sort	systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/37dc488464564ed0ad9548ea3c5ae7b6
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Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation

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