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 (target
international normalised ratio 2.0–3.0), acetylsalicylic acid (ASA), ASA
and clopidogrel) for non-valvular atrial fibrillation and among
subpopulations. Design: Systematic review and network meta-analysis. Data
sources: A systematic literature search strategy was designed and carried
out using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and
the grey literature including the websites of regulatory agencies and
health technology assessment organisations for trials published in English
from 1988 to January 2014. Eligibility criteria for selecting studies:
Randomised controlled trials were selected for inclusion if they were
published in English, included 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 150 mg 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 1000
patients treated for dabigatran 150 mg twice daily to 15 more events for
clopidogrel plus ASA. For major bleeding, edoxaban 30 mg daily, apixaban,
edoxaban 60 mg daily and dabigatran 110 mg twice daily were associated
with reductions compared to standard adjusted dose VKA. Absolute risk
reductions with these agents ranged from 18 fewer per 1000 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 subpopulations, rigorously
conducted comparative studies or network meta-regression analyses of
patient-level data are required.