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  • Non-vitamin-K oral anticoagulants reduce mortality, stroke and intracranial haemorrhage when compared with warfarin in randomised trials of patients with non-valvular atrial fibrillation

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Therapeutics
Systematic review and meta-analysis
Non-vitamin-K oral anticoagulants reduce mortality, stroke and intracranial haemorrhage when compared with warfarin in randomised trials of patients with non-valvular atrial fibrillation
  1. Benjamin A Steinberg
  1. Electrophysiology Section, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, USA
  1. Correspondence to : Dr Benjamin A Steinberg, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA; benjamin.steinberg{at}duke.edu

https://doi.org/10.1136/ebmed-2014-110004

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    Commentary on: Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955–62.OpenUrlCrossRefPubMedWeb of Science

    Context

    Historically, the standard medication for stroke prevention in atrial fibrillation (AF) has been a vitamin-K antagonist (warfarin). However, several non-vitamin-K oral anticoagulants (NOACs) have been developed and shown to be at least as effective as dose-adjusted warfarin in their respective phase-3 clinical trials.1–4 These include the direct thrombin inhibitor dabigatran and the factor Xa inhibitors rivaroxaban, apixaban and edoxaban. Yet, despite these large trials, there remains limited power to examine certain end points and treatment effects in subgroups.

    Methods

    In a prespecified meta-analysis, the authors pooled trial-level data from the four existing phase-3 randomised clinical trials comparing a NOAC …

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    Footnotes

    • Competing interests BAS was funded by NIH T-32 training grant #5 T32 HL 7101-38, and reports significant research support from Janssen Pharmaceuticals, Inc.

    • Provenance and peer review Commissioned; internally peer reviewed.