title: Direct oral factor Xa inhibitors for the prevention of non-central nervous systemic embolism patients with non-valvular atrial fibrillation - a systematic review and meta-analysis.
abstract: BACKGROUND
  The aim of this systematic review and meta-analysis was to evaluate the efficacy of direct oral factor Xa inhibitors for preventing non-central nervous systemic embolism in patients with non-valvular atrial fibrillation.
  
  
  METHODS
  We conducted a systematic review of the following databases: Ovid MEDLINE, EUROPUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials, from July 1st 1990 to April 1st, 2015. Randomised controlled trials were included if they reported the outcomes of patients with non-valvular atrial fibrillation treated with a direct oral factor Xa inhibitors compared to a vitamin K antagonist. The primary outcome was objectively confirmed as non-central nervous systemic embolism and ischaemic stroke was the secondary outcome. The random-effects model odds ratio was used as the outcome measure.
  
  
  RESULTS
  Our initial search identified 987 relevant articles, of which three satisfied our inclusion criteria and were included. Compared to vitamin K antagonists targeting an INR between 2 and 3, direct oral factor Xa inhibitors alone did not reduce the incidence of non-central nervous systemic embolism [OR 0.63 (95 % CI 0.30 - 1.35)] or ischaemic stroke [OR 1.06 (95 % CI 0.86 - 1.32)].
  
  
  CONCLUSIONS
  As a drug class, direct oral factor Xa inhibitors do not reduce the incidence of non-central nervous systemic embolism (or ischaemic stroke) in patients with non-valvular atrial fibrillation. Selecting drugs for the prevention of non-central nervous systemic embolism in patients with non-valvular atrial fibrillation should be based on individual drug efficacy data, rather than class data.
authors.affiliation: 1 University of Ottawa Faculty of Medicine, Ottawa, Canada.
authors.forename: Victoria
authors.initials: V
authors.lastname: Gandara
authors.affiliation: 1 University of Ottawa Faculty of Medicine, Ottawa, Canada.
authors.forename: Fernando
authors.initials: F
authors.lastname: Vazquez
authors.affiliation: 1 University of Ottawa Faculty of Medicine, Ottawa, Canada.
authors.forename: Esteban
authors.initials: E
authors.lastname: Gandara
mesh_terms: D000284:Administration, Oral; D001281:Atrial Fibrillation / Q000150:complications*; D004617:Embolism / Q000517:prevention & control*; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D006801:Humans
chemical_list: D065427:Factor Xa Inhibitors
keywords: Atrial fibrillation; apixaban; edoxaban; rivaroxaban; systemic embolism