title: Relative efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation by network meta-analysis.
abstract: BACKGROUND
  Much direct evidence has proved that the novel oral anticoagulants (NOACs) are noninferior or superior to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation, and lead to a relevant decrease in bleeding profiles. However, no study has compared NOACs with each other head-to-head. The current study is a network meta-analysis aiming to assess the efficacy and safety of NOACs.
  
  
  METHODS
  Cochrane library, Pubmed NCBI, EMBASE and MEDLINE were systematically searched for randomized controlled trials that assessed the efficacy and safety profiles of NOACs compared with warfarin. The primary outcome was the rate of stroke or systemic embolism, and the secondary outcome was the rate of bleeding events. Network meta-analysis was performed using Markov chain Monte Carlo methods.
  
  
  RESULTS
  A total of four phase III randomized controlled trials (n = 71683) met the inclusion criteria. All NOACs except low dose of edoxaban showed noninferior efficacies to warfarin in stroke prevention. In the field of hemorrhage, apixaban was safer than edoxaban 60 mg in any bleeding events and had fewer major bleeding events compared with dabigatran 150 mg and rivaroxaban.
  
  
  CONCLUSIONS
  NOACs are promising candidates for stroke prevention in patients with nonvalvular atrial fibrillation due to a favorable risk-benefit profile. All NOACs other than edoxaban 30 mg had parallel efficacies with respect to stroke prevention. Apixaban had an advantage over the other NOACs in safety.
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Wenbin
authors.initials: W
authors.lastname: Fu
authors.forename: Hongyang
authors.initials: H
authors.lastname: Guo
authors.forename: Jianping
authors.initials: J
authors.lastname: Guo
authors.forename: Kun
authors.initials: K
authors.lastname: Lin
authors.forename: Haijun
authors.initials: H
authors.lastname: Wang
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yutang
authors.initials: Y
authors.lastname: Wang
authors.forename: Zhaoliang
authors.initials: Z
authors.lastname: Shan
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001777:Blood Coagulation / Q000187:drug effects*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants