Cardiology Xagena

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Xagena Newsletter
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Novel oral anticoagulants in patients with atrial fibrillation: comparative efficacy and safety

A study has compared efficacy and safety among novel oral anticoagulants ( NOACs ), which have not been directly compared in randomized control trials to date.

Investigators performed network meta-analyses of randomized control trials in preventing thromboembolic events and major bleeding in patients with atrial fibrillation.
All phase III randomized controlled trials ( RCTs ) of novel oral anticoagulants ( Apixaban [ Eliquis ], Edoxaban [ Lixiana ], Dabigatran [ Pradaxa ], Rivaroxaban [ Xarelto ] ), Idraparinux, and Ximelagatran were reviewed.

A systematic literature search identified nine phase III RCTs for primary analyses.

The efficacy of each NOAC was similar with respect to the primary composite endpoint following adjustment for open label designs [ odds ratios ( ORs ) versus vitamin K antagonists: Apixaban 0.79; Dabigatran 150mg 0.77; Edoxaban 60mg 0.87; Rivaroxaban 0.86 ] except for Dabigatran 110mg and Edoxaban 30mg.

Apixaban and Edoxaban 30mg and 60mg had significantly fewer major bleeding events than Dabigatran 150mg, Rivaroxaban, and vitamin K antagonists.

All novel oral anticoagulants were similar in reducing secondary endpoints with the exception of Dabigatran 110mg and 150mg which were associated with a significantly greater incidence of myocardial infarction compared to Apixaban, Edoxaban 60mg, and Rivaroxaban.

In conclusion, the indirect comparison with adjustment for study design suggests that the efficacy of the examined novel oral anticoagulants is similar across drugs, but that some differences in safety and risk of myocardial infarction exist, and that open label study designs appear to overestimate safety and treatment efficacy.
Differences in study design should be taken into account in the interpretation of results from randomized controlled trials of novel oral anticoagulants. ( Xagena )

Morimoto T et al, J Cardiol 2015; Epub ahead of print