Meta-Analysis of Efficacy and Safety of New Oral Anticoagulants in Atrial Fibrillation Therapy
SUN Xiu-bo1,2,TIE Yuan1,2,CHEN Qing1,2,HE Yi-chen1,2,LIU Lei1*
1. Pharmaceutical Department, Beijing Hospital,Beijing 100730, China; 2.Department of Pharmacy Administration and Clinical Pharmacy,School of Pharmaceutical Science, Peking University Health Science Center, Beijing 100191,China
Abstract��OBJECTIVE To evaluate the efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) in the treatment of atrial fibrillation. METHODS The randomized controlled trials of new oral anticoagulants versus warfarin in the treatment of atrial fibrillation, which had been published from the time of library foundation to May, 2015, were collected from Pubmed, Embase, Medline, Cochrane, ClinicalTrials.gov, CNKI, Wanfang database, and VIP database according to the inclusion criterias. At the same time the quality of the trials was evaluated and the RESULTS of studies were analyzed using RevMan 5.3 software and Stata 13.1 software. RESULTS Eleven randomized controlled trials were included, involving 75 621 patients. Meta-analysis showed that compared with warfarin, the new oral anticoagulants significantly reduced the incidences of all-cause mortality [RR=0.90, 95% CI (0.85, 0.94), P<0.000 1], stroke and systemic embolism [RR=0.86, 95% CI(0.79, 0.93), P=0.000 1], major bleeding [RR=0.79, 95% CI(0.74, 0.84), P<0.000 01], and intracranial bleeding[RR=0.43, 95% CI(0.37, 0.51), P<0.000 01]. No differences were found in the incidence of ischemic stroke [RR=1.02, 95% CI (0.93, 1.12), P=0.71] and myocardial infarction [RR=1.02, 95% CI (0.91, 1.16), P=0.70]. Heterogeneity was lower through subgroup analysis, no publication bias was found in funnel plots of most outcomes, and sensitivity analysis indicated the RESULTS were reliable. CONCLUSION The efficacy and safety of new oral anticoagulants are better than warfarin, which may have broad prospects.
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SUN Xiu-bo,TIE Yuan,CHEN Qing,HE Yi-chen,LIU Lei. Meta-Analysis of Efficacy and Safety of New Oral Anticoagulants in Atrial Fibrillation Therapy. Chinese Pharmaceutical Journal, 2016, 51(5): 417-424.
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2016, Vol. 51 
