Does X(a) mark the spot? An indirect mixed treatment comparison of Xa inhibitors compared to warfarin for patients with atrial fibrillation

Abstract

The study sets out to compare the safety and efficacy of oral Non-vitamin K antagonists and warfarin in patients with atrial fibrillation. BackgroundPatients with atrial fibrillation carry a higher than normal risk for stroke, thus making them dependent on long-term anticoagulation treatment. While warfarin is considered to be the gold standard, several of its attributes, hinder adherence of patients to the therapeutic regimen. A new therapeutic category, the oral Non-vitamin K antagonist oral anticoagulants, aims to provide better and safer care to patients presenting with atrial fibrillation. MethodAn indirect mixed treatment comparison using data from published randomised controlled trials. ResultsLooking at the primary efficacy endpoint of stroke or systematic embolism, apixaban, rivaroxaban and dabigatran, demonstrated significant superiority compared to warfarin, while a trend exists for edoxaban [OR: 0.84 (95% CI 0.74–1.02)]. At the primary safety endpoint of major bleeding, evidence suggest that apixaban and edoxaban are superior to warfarin. Warfarin proved to be safer regarding gastrointestinal bleeding, compared to rivaroxaban, dabigatran and edoxaban. At the secondary efficacy endpoints of hemorrhagic and intracranial stroke, all Non-vitamin K antagonists oral anticoagulants were related to reduced risk versus warfarin. ConclusionsThe Non-vitamin K antagonist oral anticoagulants constitute a new and promising category in the field of atrial fibrillation, even in the context of uncertainty, which an indirect comparison yields.