title: The efficacy and safety of oral anticoagulants in warfarin-suitable patients with nonvalvular atrial fibrillation: systematic review and meta-analysis.
abstract: The novel oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban have been recently indicated for stroke prevention in patients with atrial fibrillation (AF) . Due to a lack of direct head-to-head trials comparing the NOACs, the current systematic review and network meta-analysis (NMA) were conducted to assess their relative efficacy and safety. Three phase III randomized controlled trials enrolling 50 578 patients were included. Results of the NMA show a clear trend favoring NOACs over warfarin with regard to the key outcomes of stroke/systemic embolism and all-cause mortality, with apixaban also showing a favorable response for major bleeding and total discontinuations. Although there were few significant differences among the NOACS with regard to efficacy outcomes, apixaban and dabigatran 110 mg were associated with significantly lower hazards of major bleeding compared with dabigatran 150 mg and rivaroxaban. The NOACs offer a therapeutic advance over standard warfarin treatment in stoke prevention in patients with nonvalvular AF.
authors.affiliation: 1Consultant Systematic Review, Abacus International, Bicester, UK.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Mitchell
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Simon
authors.forename: Syed
authors.initials: S
authors.lastname: Raza
authors.forename: David
authors.initials: D
authors.lastname: Jakouloff
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Orme
authors.forename: Ian
authors.initials: I
authors.lastname: Lockhart
authors.forename: Pieter
authors.initials: P
authors.lastname: Drost
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulants; bleeding; stroke