%0 Journal Article
%T Meta-analysis of real-world evidence comparing non-vitamin K antagonist oral anticoagulants with vitamin K antagonists for the treatment of patients with non-valvular atrial fibrillation
%A Aur谷lie Millier
%A Craig I. Coleman
%A Jean-Baptiste Briere
%A Kevin Bowrin
%A Laurent Fauchier
%A Mondher Toumi
%A Olivia Wu
%A Pierre Levy
%A Vanessa Taieb
%J Journal of Market Access & Health Policy
%D 2019
%R https://doi.org/10.1080/20016689.2019.1574541
%X ABSTRACT Introduction: Numerous real-world studies have compared non-vitamin K antagonist oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF). A meta-analysis was performed to synthesize the available evidence. Methods: Systematic searches were performed through 12/2016 to identify non-randomized NVAF studies comparing NOACs with VKAs, and reporting effectiveness, safety, or persistence. Results: Of 562 citations identified, 49, 79, and 18 compared rivaroxaban, dabigatran, and apixaban, respectively, with VKAs and were included. Compared with VKAs, rivaroxaban was associated with a reduced risk of ischemic stroke (IS) (hazard ratio [HR] = 0.83, 95% confidence interval [CI] = 0.75每0.93), intracranial haemorrhage (ICH) (HR = 0.69, 95% CI = 0.52每0.90), and non-persistence (HR = 0.62, 95% CI = 0.60每0.65). Dabigatran was associated with a significantly lower risk of IS (HR = 0.80, 95% CI = 0.65每0.98) and ICH (HR = 0.45, 95% CI = 0.36每0.58), but not for non-persistence (HR = 0.91, 95% CI = 0.53每1.55), compared with VKAs. Apixaban was associated with a lower risk of ICH than VKAs (HR = 0.41, 95% CI = 0.28每0.60), but was not different to VKAs in terms of IS (HR = 1.01, 95% CI = 0.87每1.17) or non-persistence (HR = 1.08, 95% CI = 0.81每1.45). Conclusion: NOACs appear to be at least as effective and safe as VKAs for stroke prevention in patients with NVAF
%U https://www.tandfonline.com/doi/full/10.1080/20016689.2019.1574541