Indirect Comparisons of New Oral Anticoagulant Drugs for Efficacy and Safety When Used for Stroke Prevention in Atrial Fibrillation
JACC Cardiovascular Interventions, 07/05/2012
Lip GYH et al. – Notwithstanding the limitations of an indirect comparison study, the authors found no profound significant differences in efficacy between apixaban and dabigatran etexilate (both doses) or rivaroxaban. Dabigatran 150 mg twice daily (BID) was superior to rivaroxaban for some efficacy endpoints, whereas major bleeding was significantly lower with dabigatran 110 mg BID or apixaban. Only a head–to–head direct comparison of the different new oral anticoagulants (OACs) would fully answer the question of efficacy/safety differences between the new drugs for stroke prevention in AF.Methods
- Indirect comparison analysis was performed using data from the published trials.
- There was a significantly lower risk of stroke and systemic embolism (by 26%) for dabigatran (150 mg BID) compared with rivaroxaban, as well as hemorrhagic stroke and nondisabling stroke.
- There were no significant differences for apixaban versus dabigatran (both doses) or rivaroxaban; or rivaroxaban versus dabigatran 110 mg BID in preventing stroke and systemic embolism.
- For ischemic stroke, there were no significant differences between the new OACs.
- Major bleeding was significantly lower with apixaban compared with dabigatran 150 mg BID (by 26%) and rivaroxaban (by 34%), but not significantly different from dabigatran 110 mg BID.
- There were no significant differences between apixaban and dabigatran 110 mg BID in safety endpoints.
- Apixaban also had lower major or clinically relevant bleeding (by 34%) compared with rivaroxaban.
- When compared with rivaroxaban, dabigatran 110 mg BID was associated with less major bleeding (by 23%) and intracranial bleeding (by 54%).
- There were no significant differences in myocardial infarction events between the dabigatran (both doses) and apixaban.