title: Rivaroxaban and risk of myocardial infarction: insights from a meta-analysis and trial sequential analysis of randomized clinical trials.
abstract: OBJECTIVE
  To evaluate the risk of myocardial infarction (MI) associated with the use of rivaroxaban.
  
  
  METHODS
  We searched PubMed, CINAHL, Cochrane CENTRAL, Scopus, and the Web of Science for randomized controlled trials of rivaroxaban that reported on MI as clinical outcomes. We express the associations as odds ratios and their 95% confidence intervals. A trial sequential analysis was carried out to ensure validity of our findings.
  
  
  RESULTS
  Nine trials were selected (N=53 827), including one study on stroke prophylaxis in atrial fibrillation, two in acute coronary syndrome, four of short-term prophylaxis of deep venous thrombosis, and two for treatment of deep venous thrombosis/pulmonary embolism. Control arms included warfarin, enoxaparin, or placebo administration. Rivaroxaban was associated with a significantly lower risk of MI compared with the agents used in the control group (odds ratio, 0.82; 95% confidence interval, 0.72-0.94; P=0.004). No heterogeneity was noted in the risk (I=0%; P=0.55); trial sequential analysis reinforced the validity of our findings.
  
  
  CONCLUSIONS
  Rivaroxaban is associated with a significantly lower risk of MI in a broad spectrum of patients when tested against different controls.
authors.affiliation: aSt Luke's-Roosevelt Hospital, Columbia University, New York bMaimonides Medical Center, Brooklyn, New York cCleveland Clinic Foundation, Cleveland, Ohio dTexas Tech University Health Sciences Center, El Paso, Texas, USA eDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Edgar
authors.initials: E
authors.lastname: Lichstein
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D006801:Humans; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D016017:Odds Ratio; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban