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dc.contributor.authorLi, Guowei
dc.contributor.authorLip, Gregory YH
dc.contributor.authorHolbrook, Anne
dc.contributor.authorChang, Yaping
dc.contributor.authorLarsen, Torben B
dc.contributor.authorSun, Xin
dc.contributor.authorTang, Jie
dc.contributor.authorMbuagbaw, Lawrence
dc.contributor.authorWitt, Daniel M
dc.contributor.authorCrowther, Mark
dc.contributor.authorThabane, Lehana
dc.contributor.authorLevine, Mitchell AH
dc.date.accessioned2019-10-08T08:13:17Z
dc.date.available2019-10-08T08:13:17Z
dc.date.issued2018-06-08
dc.identifier.citationLi, G., Lip, G.Y.H., Holbrook, A. et al. (2018) Direct comparative effectiveness and safety between non-vitamin K antagonist oral anticoagulants for stroke prevention in nonvalvular atrial fibrillation: a systematic review and meta-analysis of observational studies, European Journal of Epidemiology, 34: 173. https://doi.org/10.1007/s10654-018-0415-7en
dc.identifier.issn0393-2990en
dc.identifier.doi10.1007/s10654-018-0415-7en
dc.identifier.urihttp://hdl.handle.net/2436/622800
dc.description.abstractThe non-vitamin K antagonist oral anticoagulants (NOACs) have been increasingly prescribed in clinical practice for stroke prevention in patients with nonvalvular atrial fibrillation (AF). Direct comparisons between NOACs in trials are lacking, leaving an important clinical decision-making gap. We aimed to perform a systematic review and meta-analysis to summarize the evidence of observational studies for direct comparative effectiveness and safety amongst NOACs in patients with AF. Conference proceedings and electronic databases including MEDLINE, CINAHL, EMBASE and PUBMED were systematically searched. We included observational studies directly comparing individual NOACs in patients with nonvalvular AF who were aged ≥ 18 years for stroke prevention. Primary outcome included effectiveness outcome (stroke or systemic embolism) and safety outcome (major bleeding). Data were extracted in duplicated by two reviewers independently. A random-effects meta-analysis was conducted to synthesize the data from included observational studies. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to rate the overall quality of evidence for each outcome. Fifteen studies were included for qualitative synthesis, twelve studies for meta-analyses. It was found that rivaroxaban and dabigatran were similar with regard to risk of stroke or systemic embolism (Hazard ratio [HR] = 1.00, 95% CI 0.91–1.10; evidence quality: low), but rivaroxaban was associated with higher risk of major bleeding (HR = 1.39, 95% CI 1.28–1.50; evidence quality: moderate). Compared with apixaban, a significantly higher risk of major bleeding was observed with rivaroxaban (HR = 1.71, 95% CI 1.51–1.94; evidence quality: low). Apixaban was associated with lower risk of major bleeding, in comparison with dabigatran (HR = 0.80, 95% CI 0.68–0.95; evidence quality: low). No differences in risk of stroke or systemic embolism was observed between rivaroxaban versus apixaban, and apixaban versus dabigatran. In this study, apixaban was found to have the most favorable safety profile amongst the three NOACs. No significant difference was observed in risk of stroke or systemic embolism between the NOACs. Such findings may provide some decision-making support for physicians regarding their choices amongst NOACs in patients with AF.en
dc.formatapplication/PDFen
dc.languageen
dc.language.isoenen
dc.publisherSpringer Science and Business Media LLCen
dc.relation.urlhttps://link.springer.com/article/10.1007%2Fs10654-018-0415-7en
dc.subjectnon-vitamin K antagonist oral anticoagulanten
dc.subjectstrokeen
dc.subjectmajor bleedingen
dc.subjectatrial fibrillationen
dc.subjectdirect comparisonen
dc.titleDirect comparative effectiveness and safety between non-vitamin K antagonist oral anticoagulants for stroke prevention in nonvalvular atrial fibrillation: a systematic review and meta-analysis of observational studiesen
dc.typeJournal articleen
dc.identifier.eissn1573-7284
dc.identifier.journalEuropean Journal of Epidemiologyen
dc.date.updated2019-09-19T12:51:38Z
dc.date.accepted2018-05-25
rioxxterms.funderGuangzhou Medical Universityen
rioxxterms.identifier.projectUOW08102019JTen
rioxxterms.versionAMen
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
rioxxterms.licenseref.startdate2019-10-08en
dc.source.volume34
dc.source.issue2
dc.source.beginpage173
dc.source.endpage190
dc.description.versionPublished version
refterms.dateFCD2019-10-08T08:12:43Z
refterms.versionFCDAM
refterms.dateFOA2019-10-08T08:13:17Z


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