ReviewMeta-Analysis of Efficacy and Safety of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) Versus Warfarin in Patients With Atrial Fibrillation
Section snippets
Methods
We systematically searched the published medical research for RCTs comparing new oral anticoagulants to warfarin in patients with AF. The Cochrane Library, Embase, MEDLINE, Science Citation Index Expanded, and ProQuest's Dissertations and Theses databases were searched from inception through July 2011 without language restriction. The following were used as Medical Subject Heading terms and/or keywords: “new oral anticoagulants,” “oral thrombin inhibitors,” “oral factor Xa inhibitors,”
Results
Our electronic search identified a total of 3,167 reports (Figure 1). After removing duplicates, we screened titles and abstracts, and the full text of 44 publications was retrieved and evaluated for eligibility. Three trials that met our inclusion criteria were identified and included in the present study. One trial was published as an original report3 with a follow-up report providing additional data.9 The other 2 trials were presented as ClinicalTrials.gov entries and were subsequently
Discussion
Our study was designed to compare the efficacy and safety of new oral anticoagulants to that of warfarin in patients with AF. Our systematic search identified 3 trials, evaluating the new oral anticoagulants apixaban,2 dabigatran,3 and rivaroxaban.4 In our meta-analysis, we found that the new oral anticoagulants reduced the risk for a composite end point of stroke and systemic embolism compared to warfarin. New oral anticoagulants were also found to be associated with a lower risk for key
Acknowledgment
We would like to thank Tara Dourian (Jewish General Hospital/McGill University) for her help with data extraction.
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Mr. Miller is supported by the Ivan Racheff and Clarke McLeod Scholarships funded through the McGill University Research Bursary Program. Dr. Shimony is supported by the Azrieli Fellowship Fund for research at the Jewish General Hospital, Montreal, Quebec, Canada. Dr. Eisenberg is a Chercheur-National of the Fonds de la Recherche en Santé du Quebec.