Data from: Systematic review and network meta-analysis comparing antithrombotic agents for the prevention of stroke and major bleeding in patients with atrial fibrillation

Objective: To examine the comparative efficacy and safety of antithrombotic treatments (apixaban, dabigatran, edoxaban, rivaroxaban, and vitamin K antagonists (VKA) at a standard adjusted dose, acetylsalicylic acid, acetylsalicylic acid and clopidogrel) for non-valvular atrial fibrillation and among sub-populations. Design: Systematic review and network meta-analysis. Data sources: A systematic literature search strategy using MEDLINE, EMBASE, Cochrane Register of Controlled Trials, and grey literature including the websites of regulatory agencies for trials published in English from 1988 to January 2014. Eligibility criteria for selecting studies: Randomized controlled trials were included if they were published in English, used at least one antithrombotic treatment and involved patients with non-valvular atrial fibrillation eligible to receive anticoagulant therapy. Results: For stroke or systemic embolism, dabigatran 150mg and apixaban twice daily were associated with reductions relative to standard adjusted dose VKA whereas low-dose ASA and the combination of clopidogrel plus low-dose ASA were associated with increases. Absolute risk reductions ranged from 6 fewer events per 1,000 patients treated for dabigatran 150mg twice daily to 15 more events for clopidogrel plus ASA. For major bleeding, edoxaban 30mg daily, apixaban, edoxaban 60mg daily, and dabigatran 110mg twice daily were associated with reductions compared to standard adjusted dose VKA. Absolute risk reductions with these agents ranged from 18 fewer per 1,000 patients treated each year for edoxaban 30 mg daily to 24 more for medium dose ASA. Conclusions: Compared with standard adjusted dose VKA, new oral anticoagulants were associated with modest reductions in the absolute risk of stroke and major bleeding. People on antiplatelet drugs experienced more strokes compared with anticoagulant drugs without any reduction in bleeding risk. To fully elucidate the comparative benefits and harms of antithrombotic agents across the various sub-populations, rigorously conducted comparative studies or network meta-regression analyses of patient-level data are required.