TY - JOUR
T1 - Real-World Use of Apixaban for Stroke Prevention in Atrial Fibrillation
T2 - A Systematic Review and Meta-Analysis
AU - Proietti, Marco
AU - Romanazzi, Imma
AU - Romiti, Giulio Francesco
AU - Farcomeni, Alessio
AU - Lip, Gregory Y H
N1 - This article has been found as a 'Free Version' from the Publisher on September 27th 2018. When the access to the article closes, please notify vbn@aub.aau.dk”
PY - 2018/1
Y1 - 2018/1
N2 - BACKGROUND AND PURPOSE: The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibrillation.METHODS: We performed a systematic review and meta-analysis of all observational real-world studies comparing apixaban with other available oral anticoagulant drugs.RESULTS: From the original 9680 results retrieved, 16 studies have been included in the final meta-analysis. Compared with warfarin, apixaban regular dose was more effective in reducing any thromboembolic event (odds ratio: 0.77; 95% confidence interval: 0.64-0.93), but no significant difference was found for stroke risk. Apixaban was as effective as dabigatran and rivaroxaban in reducing thromboembolic events and stroke. The risk of major bleeding was significantly lower for apixaban compared with warfarin, dabigatran, and rivaroxaban (relative risk reduction, 38%, 35%, and 46%, respectively). Similarly, the risk for intracranial hemorrhage was significantly lower for apixaban than warfarin and rivaroxaban (46% and 54%, respectively) but not dabigatran. The risk of gastrointestinal bleeding was lower with apixaban when compared with all oral anticoagulant agents (P<0.00001 for all comparisons).CONCLUSIONS: Use of apixaban in real-life is associated with an overall similar effectiveness in reducing stroke and any thromboembolic events when compared with warfarin. A better safety profile was found with apixaban compared with warfarin, dabigatran, and rivaroxaban.
AB - BACKGROUND AND PURPOSE: The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibrillation.METHODS: We performed a systematic review and meta-analysis of all observational real-world studies comparing apixaban with other available oral anticoagulant drugs.RESULTS: From the original 9680 results retrieved, 16 studies have been included in the final meta-analysis. Compared with warfarin, apixaban regular dose was more effective in reducing any thromboembolic event (odds ratio: 0.77; 95% confidence interval: 0.64-0.93), but no significant difference was found for stroke risk. Apixaban was as effective as dabigatran and rivaroxaban in reducing thromboembolic events and stroke. The risk of major bleeding was significantly lower for apixaban compared with warfarin, dabigatran, and rivaroxaban (relative risk reduction, 38%, 35%, and 46%, respectively). Similarly, the risk for intracranial hemorrhage was significantly lower for apixaban than warfarin and rivaroxaban (46% and 54%, respectively) but not dabigatran. The risk of gastrointestinal bleeding was lower with apixaban when compared with all oral anticoagulant agents (P<0.00001 for all comparisons).CONCLUSIONS: Use of apixaban in real-life is associated with an overall similar effectiveness in reducing stroke and any thromboembolic events when compared with warfarin. A better safety profile was found with apixaban compared with warfarin, dabigatran, and rivaroxaban.
KW - Apixaban
KW - Atrial fibrillation
KW - Major bleeding
KW - Stroke
KW - Warfarin
UR - https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.117.018395
UR - http://www.scopus.com/inward/record.url?scp=85043682389&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.117.018395
DO - 10.1161/STROKEAHA.117.018395
M3 - Review article
C2 - 29167388
SN - 0039-2499
VL - 49
SP - 98
EP - 106
JO - Stroke
JF - Stroke
IS - 1
ER -