title: Safety and efficacy of non-vitamin K oral anticoagulants in non-valvular atrial fibrillation: a Bayesian meta-analysis approach.
abstract: BACKGROUND
  Choosing between different non-vitamin K antagonist oral anticoagulants (NOACs) in non-valvular atrial fibrillation (NVAF) is difficult due to the absence of head to head comparative studies. We performed a Bayesian meta-analysis to explore similarities and differences between different NOACs and to rank treatments overall for safety and efficacy outcomes.
  
  
  METHODS
  Through a systematic literature search we identified randomized controlled Phase III trials of dabigatran, rivaroxaban, apixaban, and edoxaban versus adjusted-dose warfarin in patients with NVAF.
  
  
  CONCLUSIONS
  Warfarin ranked worst for all-cause mortality and intracranial bleedings and had a nil probability of ranking first for any outcome. The risk of major bleeding versus warfarin was lower with apixaban, dabigatran 110 mg, and both doses of edoxaban. All agents reduced the risk of intracranial bleeding versus warfarin. Edoxaban 30 mg was the best among the treatments being compared for major and gastrointestinal bleeding. Dabigatran 150 mg was the best for stroke and systemic embolism. This study suggests that NOACs are generally preferable to warfarin in patients with NVAF. However, safety and efficacy differences do exist among NOACs, which might drive their use in specific subsets of AF patients, allowing prescribers to tailor treatment to distinct patient profiles.
authors.affiliation: Hospital of Assisi, Department of Medicine , Via Valentin Müller 1, 06081 Assisi , Italy +075 8139301 ; verdec@tin.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Claudia
authors.initials: C
authors.lastname: Bartolini
authors.forename: Valentina
authors.initials: V
authors.lastname: De Filippo
authors.forename: Adolfo
authors.initials: A
authors.lastname: Aita
authors.forename: Letizia
authors.initials: L
authors.lastname: Di Giacomo
authors.forename: Cristina
authors.initials: C
authors.lastname: Poltronieri
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001499:Bayes Theorem; D002543:Cerebral Hemorrhage / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D000925:Anticoagulants
keywords: apixaban; atrial fibrillation; bleeding; dabigatran; edoxaban; mortality; rivaroxaban; stroke; warfarin