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Clinical Articles, News & Views

Benefits of NOACs in AF

Novel oral anticoagulants (NOACs) are associated with an overall clinical benefit compared with vitamin K antagonists, according to a study1 published recently in Circulation.

Researchers performed a meta-analysis of phase II and phase III trials comparing NOACs with vitamin K antagonists in patients with atrial fibrillation (AF). The MEDLINE and EMBASE databases, supplemented with conference abstract books and www.clinicaltrials.gov, were searched up to the first week of July 2012 with no language restriction.

Two reviewers performed independent article review and study quality assessment. Data on overall and cardiovascular mortality, stroke or systemic embolism, ischaemic stroke, major and intracranial bleeding, and myocardial infarction were collected. NOACs were pooled to perform a comparison with vitamin K antagonists.

They retrieved 12 studies (three administering dabigatran, four administering rivaroxaban, two administering apixaban, and three administering edoxaban) enrolling a total of 54,875 patients. NOACs significantly reduced total mortality (5.61% versus 6.02%), cardiovascular mortality (3.45% versus 3.65%), and stroke/systemic embolism (2.40% versus 3.13%). There was a trend toward reduced major bleeding with a significant reduction of intracranial haemorrhage. No difference in myocardial infarction was observed.

Individually, NOACs had previously been shown to be at least noninferior to vitamin K antagonists, but a clear superiority in overall and vascular mortality was not consistently proven, the authors say. They conclude that additional research is required to confirm these findings outside the context of randomised trials.

References

1. Dentali F, Riva N, Crowther M, Turpie AGG, Lip GYH, Ageno W. Efficacy and safety of the novel oral anticoagulants in atrial fibrillation. Circulation 2012;126:2381–91. http://dx.doi.org/10.1161/​CIRCULATIONAHA.112.115410

Published on: December 20, 2012

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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