Safety and Efficacy of Oral Anticoagulants Therapies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-Analysis

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Mainka, FF (Author) Other; Ferreira, VL (Author) Other; Mendes, AM (Author) Other; Marques, GL (Author) Other; Fernandez Llimos, F (Author) FFUP; Tonin, FS (Author) Other; Pontarolo, R (Author) Other

Journal

Title: Journal of Cardiovascular Pharmacology and Therapeutics

Vol. 25

Pages: 399-408

ISSN: 1074-2484

Publisher: SAGE

Indexing

ISI Web of Knowledge - 3 Citations

Scopus - 4 Citations

Other information

Authenticus ID: P-00S-7VG

DOI: 10.1177/1074248420930136

Abstract (EN): Background: Different antithrombotic treatments, from vitamin K antagonists to direct oral anticoagulants (DOACs), are available to reduce ischemic risks in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Objective: To synthetize evidence about the benefit-risk ratio of antithrombotic treatments and their combinations in patients with AF and PCI. Methods: A network meta-analysis and a stochastic multicriteria acceptability analysis (SMAA) were performed including randomized controlled trials (RCT) that evaluate antithrombotic treatments in adults with AF and PCI. Searches were conducted in PubMed and Scopus (updated November-2019). Outcomes compared included bleeding, stroke, and death (Prospero registration: CRD42019146813). Results: Five RCTs were included (11 532 patients). Vitamin K antagonists + dual antiplatelet therapy was associated with major bleeding (odds ratio: 0.52 [95% CI: 0.32-0.86]) compared to DOAC + P2Y12. No statistical differences were found among DOAC regimens for the main outcomes, including bleeding, stroke, and death. Surface under the cumulative ranking curve analysis (SUCRA) and SMAA demonstrated edoxaban 60 mg + P2Y12 inhibitor as the worst option (28%). Apixaban 5 mg + P2Y12 inhibitor was the safest alternative (63%) in all scenarios. Conclusions: Insufficient evidence on the clinical superiority among anticoagulant regimens exists, although apixaban slightly stands out. Edoxaban was associated with more adverse events. To strength this evidence, well-designed, low risk of bias clinical trials are needed. Cost-minimization analyses are required to provide further information for clinical decision-making.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 10