title: Rivaroxaban Versus Dabigatran or Warfarin in Real-World Studies of Stroke Prevention in Atrial Fibrillation: Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  This study was designed to evaluate the effectiveness and safety of rivaroxaban in real-world practice compared with effectiveness and safety of dabigatran or warfarin for stroke prevention in atrial fibrillation through meta-analyzing observational studies.
  
  
  METHODS
  Seventeen studies were included after searching in PubMed for studies reporting the comparative effectiveness and safety of rivaroxaban versus dabigatran (n=3), rivaroxaban versus Warfarin (n=11), or both (n=3) for stroke prevention in atrial fibrillation.
  
  
  RESULTS
  Overall, the risks of stroke/systematic thromboembolism with rivaroxaban were similar when compared with those with dabigatran (stroke/thromboembolism: hazard ratio, 1.02; 95% confidence interval, 0.91-1.13; I2=70.2%, N=5), but were significantly reduced when compared with those with warfarin (hazard ratio, 0.75; 95% confidence interval, 0.64-0.85; I2=45.1%, N=9). Major bleeding risk was significantly higher with rivaroxaban than with dabigatran (hazard ratio, 1.38; 95% confidence interval, 1.27-1.49; I2=26.1%, N=5), but similar to that with warfarin (hazard ratio, 0.99; 95% confidence interval, 0.91-1.07; I2=0.0%, N=6). Rivaroxaban was associated with increased all-cause mortality and gastrointestinal bleeding, but similar risk of acute myocardial infarction and intracranial hemorrhage when compared with dabigatran. When compared with warfarin, rivaroxaban was associated with similar risk of any bleeding, mortality, and acute myocardial infarction, but a higher risk of gastrointestinal bleeding and lower risk of intracranial hemorrhage.
  
  
  CONCLUSIONS
  In this systematic review and meta-analysis, rivaroxaban was as effective as dabigatran, but was more effective than warfarin for the prevention of stroke/thromboembolism in atrial fibrillation patients. Major bleeding risk was significantly higher with rivaroxaban than with dabigatran, as was all-cause mortality and gastrointestinal bleeding. Rivaroxaban was comparable to warfarin for major bleeding, with an increased risk in gastrointestinal bleeding and decreased risk of intracranial hemorrhage.
authors.affiliation: From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (Y.B., H.D., A.S., G.Y.H.L.); Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, China (Y.B.); Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China (H.D.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Bai
authors.affiliation: From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (Y.B., H.D., A.S., G.Y.H.L.); Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, China (Y.B.); Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China (H.D.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
authors.forename: Hai
authors.initials: H
authors.lastname: Deng
authors.affiliation: From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (Y.B., H.D., A.S., G.Y.H.L.); Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, China (Y.B.); Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China (H.D.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
authors.forename: Alena
authors.initials: A
authors.lastname: Shantsila
authors.affiliation: From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (Y.B., H.D., A.S., G.Y.H.L.); Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, China (Y.B.); Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China (H.D.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.). g.y.h.lip@bham.ac.uk.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000150:complications*; D000069604:Dabigatran / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D020767:Intracranial Thrombosis / Q000209:etiology / Q000517:prevention & control*; D000069552:Rivaroxaban / Q000009:adverse effects / Q000494:pharmacology*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: atrial fibrillation; dabigatran; real-world data; rivaroxaban; warfarin