title: The efficacy and safety of novel oral anticoagulants for the preventive treatment in atrial fibrillation patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Novel oral anticoagulants, including direct factor Xa inhibitors and direct factor IIa inhibitors, have been used to prevent stroke in patients with atrial fibrillation (AF) for a decade. In this study, the efficacy and safety of the novel oral anticoagulants were assessed in AF patients.
  
  
  METHODS
  No language restrictions were applied. Study selection and data extraction were carried out by searching PubMed, EMBASE, OVID, the BIOSIS, the Web of Science, Clinical Trials Registers, Cochrane Central Register of Controlled Trials and the China Academic Library and Information System. Each database was searched from its inception date to June 2013. Using odds ratio (OR) as an indicator, we systematically evaluated the primary efficacy endpoints and safety endpoints, as well as 10 secondary endpoints.
  
  
  RESULTS
  Compared to the control drugs, the novel oral anticoagulants showed an OR decreased by 26% (OR: 0.74, 95% confidence interval (CI): 0.62-0.88) for stroke or systemic embolism, decreased by 24% (OR: 0.76, 95% CI: 0.64-0.90) for major bleeding, decreased by 10% (OR: 0.90, 95% CI: 0.84-0.95) for death from any cause, decreased by 27% for disabling or fatal stroke (OR: 0.73, 95% CI: 0.54-0.97), decreased by 31% (OR: 0.69, 95% CI: 0.60-0.8) for fatal bleeding, and decreased by 8% (OR: 0.92, 95% CI: 0.88-0.95) for serious adverse events. However, there was no significant difference in acute myocardial infarction, systemic embolism, major bleeding or clinically relevant non-major, all bleeding events, all adverse events and liver function disorder, between the novel oral anticoagulants and control drugs (p > 0.05).
  
  
  CONCLUSIONS
  Compared to the control drugs, the novel oral anticoagulants showed higher efficiency and safety in patients with AF, as evidenced by their superior performance not only in reducing the risk of stroke or systemic embolism with a lower risk of major bleeding but also in decreasing the incidence of death from any cause, disabling or fatal stroke, serious adverse events and fatal bleeding.
authors.affiliation: Department of Neurology .
authors.forename: Guang Jian
authors.initials: GJ
authors.lastname: Liu
authors.forename: Yun Fu
authors.initials: YF
authors.lastname: Wang
authors.forename: Ping You
authors.initials: PY
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Chang
authors.forename: Ming Li
authors.initials: ML
authors.lastname: Tu
authors.forename: Li Ying
authors.initials: LY
authors.lastname: Chang
authors.forename: Ping
authors.initials: P
authors.lastname: Cheng
authors.forename: Jie
authors.initials: J
authors.lastname: Luo
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004617:Embolism / Q000517:prevention & control; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; efficacy; novel oral anticoagulants; safety; stroke prevention