3/4/14

New oral anticoagulants vs warfarin in patients with AF

HOME

ABOUT PACE

LITERATURE

MEETING REPORTS

E-LEARNING

TEACHING SLIDES

WEBCASTS

LOGON

ALL

LDL CHOLESTEROL

HDL CHOLESTEROL

HYPERTENSION / HEART FAILURE

DIABETES

CV RISK

RENAL

ANTICOAGULATION

GASTROENTEROLOGY

LITERATURE

New oral anticoagulants vs warfarin in patients with AF

8-5-2012 MILLER SC ET AL. AM J CARDIOL 2012

RELATED LITERATURE

Meta-Analysis of Efficacy and Safety of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) Versus Warfarin in Patients With Atrial Fibrillation. Miller CS, Grandi SM, Shimony A, Filion KB, Eisenberg MJ. Am J Cardiol. 2012 Apr 24. [Epub ahead of print] Background The long-term use of new oral anticoagulants has been evaluated in 3 large phase III randomized controlled trials, the Apixaban for Reduction of Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial,[1] the Randomized Evaluation of Long-Term Anticoagulation Therapy (RELY) trial,[2] and the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)[3]. This metaanalysis examined the long-term efficacy and safety of the new oral anticoagulants compared to warfarin in preventing stroke and systemic embolism in patients with atrial fibrillation. Main results The new oral anticoagulants were found to be at least noninferior to warfarin for the composite end point of stroke (including hemorrhagic stroke) and systemic embolism (22% RR reduction). All 3 drugs were associated with a significantly decreased risk for hemorrhagic stroke compared to warfarin (fig. 1, 55% RR reduction). Dabigatran and rivaroxaban were found to have comparable risks for major bleeding to warfarin, while apixaban demonstrated superiority for this outcome; gastrointestinal bleedings were heterogenous. The new oral anticoagulants were each associated with a decreased risk for intracranial bleeding compared to warfarin (51% RR reduction). Forest plot for: - all-cause stroke and systemic embolism - ischemic and unspecified stroke, and - hemorrhagic stroke, new oral anticoagulants (NOA) versus warfarin in patients with AF Click on image to enlarge See left column to download as PowerPoint

ARISTOTLE: Consistent benefit of apixaban across range of patient risk scores ARISTOTLE: effect of apixaban in relation to renal function WOEST: aspirin not needed after PCI in patients treated w ith clopidogrel More related literature

UPCOMING MEETINGS

Cardio Diabetes Master Class, Asian chapter

12-4-2014, Almaty, Kazachstan

RELATED WEBCASTS

Lipid Master Class

16-5-2014, TBD

What is new in Anti-coagulation in AF and ACS Stroke Prevention in AF ENGAGE: Factor Xa inhibitor edoxaban w ith promising results More related w ebcasts

SNAPSHOT meeting 2014

30-8-2014, Barcelona, Spain

All upcoming meetings... MEETING REPORTS & RESOURCES

RELATED PRESTATIONS

CV Risk Master Class Latin American chapter

Bogota, Colombia, November 1- 2, 2013

Atrial fibrillation and stroke: Disease aw areness Management of AF r elated stroke Stratifying stroke risk to guide antithrombotic therapy in patients w ith AF More related presentations

Inflammation & cardiovascular disease: Exploring new options for intervention

ESC Amsterdam, September 2, 2012

PCSK9: the new lipid target in preventive cardiology?

RELATED NEWS ESC Amsterdam, August 31, 2013

Atrial fibrillation, stroke & anticoagulation EXAMINE: CV outcomes w ith alogliptin in patients w ith diabetes and ACS Efficacy and safety of more intensive low ering of LDL cholesterol More related new s

SNAPSHOT meeting: Novel interventions in CVD: Controversies & hot issues

All meeting reports... E-LEARNING

Statin-loaded HDL nanoparticle

Raphal Duivenvoorden

Conclusion The new oral anticoagulants are more efficacious than warfarin in preventing stroke and systemic embolism in patients with AF, with a favourable decreased risk of intracranial bleeding. References
1. Granger CB, Alexander JH, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981992. 2. Connolly SJ, Ezekowitz MD, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139 1151. 3. Patel MR, Mahaffey KW, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365:883 891.

CV Risk Master Class Latin American chapter

Applying new insights to clinical practice

The challenge for CV Risk management in Latin America:

Opportunities for early intervention

Nanotechnology: new in cardiovascular medicine

Willem Mulder All e-learning...

Abstract New oral anticoagulants, including apixaban, dabigatran, and rivaroxaban, have been developed as alternatives to warfarin, the standard oral anticoagulation therapy for patients with atrial fibrillation (AF). A systematic review and meta-analysis of randomized controlled trials was performed to compare the efficacy and safety of new oral anticoagulants to those of warfarin in patients with AF. The published research was systematically searched for randomized controlled trials of >1 year in duration that compared new oral anticoagulants to warfarin in patients with AF. Random-effects models were used to pool efficacy and safety data across randomized controlled trials. Three studies, including 44,563 patients, were identified. Patients randomized to new oral anticoagulants had a decreased risk for all-cause stroke and systemic embolism (relative risk [RR] 0.78, 95% confidence interval [CI] 0.67 to 0.92), ischemic and unidentified stroke (RR 0.87, 95% CI 0.77 to 0.99), hemorrhagic stroke (RR 0.45, 95% CI

www.pace-cme.org/d/342/new-oral-anticoagulants-vs-warfarin-in-patients-with-af

1/2

unidentified stroke (RR 0.87, 95% CI 0.77 to 0.99), hemorrhagic stroke (RR 0.45, 95% CI 0.31 to 0.68), all-cause mortality (RR 0.88, 95% CI 0.82 to 0.95), and vascular mortality (RR 0.87, 95% CI 0.77 to 0.98). Randomization to a new oral anticoagulant was associated with a lower risk for intracranial bleeding (RR 0.49, 95% CI 0.36 to 0.66). Data regarding the risks for major bleeding (RR 0.88, 95% CI 0.71 to 1.09) and gastrointestinal bleeding (RR 1.25, 95% CI 0.91 to 1.72) were inconclusive. In conclusion, the new oral anticoagulants are more efficacious than warfarin for the prevention of stroke and systemic embolism in patients with AF. With a decreased risk for intracranial bleeding, they appear to have a favorable safety profile, making them promising alternatives to warfarin.

anticoagulants systemic
Share

atrial

embolism

fibrillation

patients

safety

stroke

warfarin
Tw eet

2014 PACE - UPCOMING MEETINGS - MEETING REPORTS - WEBCASTS - LITERATURE - NEWS - TEACHING SLIDES - ABOUT PACE - PARTNERS - DISCLAIMER - COOKIES