Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis
Abstract Background The development of novel oral anticoagulants (NOACs) has changed the landscape of non-valvular atrial fibrillation (NVAF) management. In this study, the effectiveness and the safety of several NOACs were evaluated in a real-world setting among Asian patients with NVAF. Methods Th...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2019-07-01
|
Series: | BMC Cardiovascular Disorders |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12872-019-1165-5 |
id |
doaj-bbd4138419d447e8a817bd2ee4bdf166 |
---|---|
record_format |
Article |
spelling |
doaj-bbd4138419d447e8a817bd2ee4bdf1662020-11-25T03:23:26ZengBMCBMC Cardiovascular Disorders1471-22612019-07-0119111210.1186/s12872-019-1165-5Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysisJianchao Zhang0Junnan Tang1Xiaolin Cui2Bo Wang3Mengsen Bu4Yan Bai5Kai Wang6Jiacheng Guo7Deliang Shen8Jinying Zhang9Department of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Orthopaedic Surgery, University of OtagoDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou UniversityAbstract Background The development of novel oral anticoagulants (NOACs) has changed the landscape of non-valvular atrial fibrillation (NVAF) management. In this study, the effectiveness and the safety of several NOACs were evaluated in a real-world setting among Asian patients with NVAF. Methods The literature search was conducted crossing different databases including Embase, MEDLINE, and the Cochrane Library from inception through March 1, 2019, for studies which included real-world perspectives comparing the individual NOACs with each other or with warfarin among Asians with NVAF. The primary outcomes were defined as stroke or systemic embolism (SSE) and major bleeding; ischemic stroke, all-cause death as well as intracranial bleeding were classified as the secondary outcomes. Results From sixteen real-world studies, a total of 312,827 Asian patients were included in this analysis. In comparison with warfarin, the utilization of apixaban, dabigatran, and rivaroxaban significantly lowered the risk of major bleeding (apixaban: HR 0.47, 95%CI 0.35–0.63; dabigatran: HR 0.59, 95%CI 0.47–0.73; rivaroxaban: HR 0.66, 95%CI 0.52–0.83) and lessened the all-cause death rate (apixaban: HR 0.29, 95%CI 0.16–0.52; dabigatran: HR 0.40, 95%CI 0.27–0.60; rivaroxaban: HR 0.42, 95%CI 0.28–0.65). Apixaban (HR 0.59; 95%CI 0.40–0.85) reduced the possibility of ischemic stroke when compared against dabigatran. Rivaroxaban showed a higher chance of causing an ischemic stroke (HR 1.61; 95%CI 1.08–2.41) and major bleeding (HR 1.39; 95%CI 1.02–1.90) than Apixaban. Conclusions Apixaban, dabigatran and rivaroxaban were more effective than warfarin on reducing the risks of stroke and haemorrhage; meanwhile, apixaban was likely to lower the risk of major bleeding comparing to rivaroxaban. Trial registration PROSPERO registry number: CRD42018086914.http://link.springer.com/article/10.1186/s12872-019-1165-5Novel Oral anticoagulantsNon-valvular atrial fibrillationAsian patientsNetwork meta-analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jianchao Zhang Junnan Tang Xiaolin Cui Bo Wang Mengsen Bu Yan Bai Kai Wang Jiacheng Guo Deliang Shen Jinying Zhang |
spellingShingle |
Jianchao Zhang Junnan Tang Xiaolin Cui Bo Wang Mengsen Bu Yan Bai Kai Wang Jiacheng Guo Deliang Shen Jinying Zhang Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis BMC Cardiovascular Disorders Novel Oral anticoagulants Non-valvular atrial fibrillation Asian patients Network meta-analysis |
author_facet |
Jianchao Zhang Junnan Tang Xiaolin Cui Bo Wang Mengsen Bu Yan Bai Kai Wang Jiacheng Guo Deliang Shen Jinying Zhang |
author_sort |
Jianchao Zhang |
title |
Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis |
title_short |
Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis |
title_full |
Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis |
title_fullStr |
Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis |
title_full_unstemmed |
Indirect comparison of novel Oral anticoagulants among Asians with non-Valvular atrial fibrillation in the real world setting: a network meta-analysis |
title_sort |
indirect comparison of novel oral anticoagulants among asians with non-valvular atrial fibrillation in the real world setting: a network meta-analysis |
publisher |
BMC |
series |
BMC Cardiovascular Disorders |
issn |
1471-2261 |
publishDate |
2019-07-01 |
description |
Abstract Background The development of novel oral anticoagulants (NOACs) has changed the landscape of non-valvular atrial fibrillation (NVAF) management. In this study, the effectiveness and the safety of several NOACs were evaluated in a real-world setting among Asian patients with NVAF. Methods The literature search was conducted crossing different databases including Embase, MEDLINE, and the Cochrane Library from inception through March 1, 2019, for studies which included real-world perspectives comparing the individual NOACs with each other or with warfarin among Asians with NVAF. The primary outcomes were defined as stroke or systemic embolism (SSE) and major bleeding; ischemic stroke, all-cause death as well as intracranial bleeding were classified as the secondary outcomes. Results From sixteen real-world studies, a total of 312,827 Asian patients were included in this analysis. In comparison with warfarin, the utilization of apixaban, dabigatran, and rivaroxaban significantly lowered the risk of major bleeding (apixaban: HR 0.47, 95%CI 0.35–0.63; dabigatran: HR 0.59, 95%CI 0.47–0.73; rivaroxaban: HR 0.66, 95%CI 0.52–0.83) and lessened the all-cause death rate (apixaban: HR 0.29, 95%CI 0.16–0.52; dabigatran: HR 0.40, 95%CI 0.27–0.60; rivaroxaban: HR 0.42, 95%CI 0.28–0.65). Apixaban (HR 0.59; 95%CI 0.40–0.85) reduced the possibility of ischemic stroke when compared against dabigatran. Rivaroxaban showed a higher chance of causing an ischemic stroke (HR 1.61; 95%CI 1.08–2.41) and major bleeding (HR 1.39; 95%CI 1.02–1.90) than Apixaban. Conclusions Apixaban, dabigatran and rivaroxaban were more effective than warfarin on reducing the risks of stroke and haemorrhage; meanwhile, apixaban was likely to lower the risk of major bleeding comparing to rivaroxaban. Trial registration PROSPERO registry number: CRD42018086914. |
topic |
Novel Oral anticoagulants Non-valvular atrial fibrillation Asian patients Network meta-analysis |
url |
http://link.springer.com/article/10.1186/s12872-019-1165-5 |
work_keys_str_mv |
AT jianchaozhang indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT junnantang indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT xiaolincui indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT bowang indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT mengsenbu indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT yanbai indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT kaiwang indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT jiachengguo indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT deliangshen indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis AT jinyingzhang indirectcomparisonofnoveloralanticoagulantsamongasianswithnonvalvularatrialfibrillationintherealworldsettinganetworkmetaanalysis |
_version_ |
1724606307494789120 |