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Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Direct Oral Anticoagulants (DOACs) , which partially replace warfarin, have been developed as a safe and effective therapy for patients with stable coronary artery disease (SCAD) and atrial fibrillation (AF). However, the choice of DOACs and warfarin remains controversial. We conducted a network met...

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Autores principales: Ma, Fang, Yuan, Li, Wen, Xinli, Wang, Yangyang, Li, Qiaofei, Chen, Chu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9537486/
https://www.ncbi.nlm.nih.gov/pubmed/36198012
http://dx.doi.org/10.1177/10760296221131033
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author Ma, Fang
Yuan, Li
Wen, Xinli
Wang, Yangyang
Li, Qiaofei
Chen, Chu
author_facet Ma, Fang
Yuan, Li
Wen, Xinli
Wang, Yangyang
Li, Qiaofei
Chen, Chu
author_sort Ma, Fang
collection PubMed
description Direct Oral Anticoagulants (DOACs) , which partially replace warfarin, have been developed as a safe and effective therapy for patients with stable coronary artery disease (SCAD) and atrial fibrillation (AF). However, the choice of DOACs and warfarin remains controversial. We conducted a network meta-analysis (NMA) using randomized controlled trials (RCTs) through a systematic literature review to evaluate the the efficacy and safety of DOACs in SCAD and AF patients. Five RCTs with 6524 patients were included. The results showed that patients taking DOACs had a lower risk of stroke/systemic embolism (OR, 0.64; 95% CI, 0.54-0.76, P < .00001, I(2) = 89%), intracranial bleeding (OR, 0.41; 95% CI, 0.26-0.64, P = .0001, I(2) = 0%), major bleeding (OR, 0.98; 95% CI, 0.81-1.148, P = .80, I(2) = 88%), and all-cause mortality (OR, 1.04; 95% CI, 0.88-1.22, P = .66, I(2) = 51%) than those taking warfarin. Compared to warfarin, rivaroxaban (20 mg, once/day) was more advantageous in preventing stroke/systemic embolism, as was apixaban (5 mg or 2.5 mg, twice/day) in reducing major bleeding (OR, 0.79; 95% CI, 0.48-1.3) and all-cause mortality (OR, 0.97; 95% CI, 0.69-1.4). Different doses of DOACs showed obvious advantages against intracranial hemorrhage, without significant differences. Thus, DOACs have more effective than warfarin in clinical efficacy and safety.
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spelling pubmed-95374862022-10-08 Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis Ma, Fang Yuan, Li Wen, Xinli Wang, Yangyang Li, Qiaofei Chen, Chu Clin Appl Thromb Hemost Original Manuscript Direct Oral Anticoagulants (DOACs) , which partially replace warfarin, have been developed as a safe and effective therapy for patients with stable coronary artery disease (SCAD) and atrial fibrillation (AF). However, the choice of DOACs and warfarin remains controversial. We conducted a network meta-analysis (NMA) using randomized controlled trials (RCTs) through a systematic literature review to evaluate the the efficacy and safety of DOACs in SCAD and AF patients. Five RCTs with 6524 patients were included. The results showed that patients taking DOACs had a lower risk of stroke/systemic embolism (OR, 0.64; 95% CI, 0.54-0.76, P < .00001, I(2) = 89%), intracranial bleeding (OR, 0.41; 95% CI, 0.26-0.64, P = .0001, I(2) = 0%), major bleeding (OR, 0.98; 95% CI, 0.81-1.148, P = .80, I(2) = 88%), and all-cause mortality (OR, 1.04; 95% CI, 0.88-1.22, P = .66, I(2) = 51%) than those taking warfarin. Compared to warfarin, rivaroxaban (20 mg, once/day) was more advantageous in preventing stroke/systemic embolism, as was apixaban (5 mg or 2.5 mg, twice/day) in reducing major bleeding (OR, 0.79; 95% CI, 0.48-1.3) and all-cause mortality (OR, 0.97; 95% CI, 0.69-1.4). Different doses of DOACs showed obvious advantages against intracranial hemorrhage, without significant differences. Thus, DOACs have more effective than warfarin in clinical efficacy and safety. SAGE Publications 2022-10-05 /pmc/articles/PMC9537486/ /pubmed/36198012 http://dx.doi.org/10.1177/10760296221131033 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Manuscript
Ma, Fang
Yuan, Li
Wen, Xinli
Wang, Yangyang
Li, Qiaofei
Chen, Chu
Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis
title Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis
title_full Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis
title_fullStr Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis
title_full_unstemmed Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis
title_short Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis
title_sort efficacy and safety of direct oral anticoagulants in stable coronary artery disease and atrial fibrillation: a systematic review and network meta-analysis
topic Original Manuscript
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9537486/
https://www.ncbi.nlm.nih.gov/pubmed/36198012
http://dx.doi.org/10.1177/10760296221131033
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