Consistency of safety and efficacy of new oral anticoagulants across subgroups of patients with atrial fibrillation.

Détails

Ressource 1Télécharger: BIB_AFB9689A0B8A.P001.pdf (874.28 [Ko])
Etat: Public
Version: de l'auteur⸱e
ID Serval
serval:BIB_AFB9689A0B8A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Consistency of safety and efficacy of new oral anticoagulants across subgroups of patients with atrial fibrillation.
Périodique
PLoS One
Auteur⸱e⸱s
Lega J.C., Bertoletti L., Gremillet C., Chapelle C., Mismetti P., Cucherat M., Vital-Durand D., Laporte S.
Collaborateur⸱rice⸱s
Meta-Embol Group
Contributeur⸱rice⸱s
Laporte S., Mismetti P., Zufferey P., Couturaud F., Cucherat M., Gueyffier F., Leizorovicz A., Meyer G., Samama CM., Steg G., Albaladejo P., Bertoletti L., Chapelle C., Garnier P., Labruyère C., Mottet N., Girard P., Marret E., Parent F., Rosencher N., Lega JC., Nony P., Wahl D.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Statut éditorial
Publié
Date de publication
2014
Peer-reviewed
Oui
Volume
9
Numéro
3
Pages
e91398
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov'tPublication Status: epublish
Résumé
AIMS: The well-known limitations of vitamin K antagonists (VKA) led to development of new oral anticoagulants (NOAC) in non-valvular atrial fibrillation (NVAF). The aim of this meta-analysis was to determine the consistency of treatment effects of NOAC irrespective of age, comorbidities, or prior VKA exposure.
METHODS AND RESULTS: All randomized, controlled phase III trials comparing NOAC to VKA up to October 2012 were eligible provided their results (stroke/systemic embolism (SSE) and major bleeding (MB)) were reported according to age (≤ or >75 years), renal function, CHADS2 score, presence of diabetes mellitus or heart failure, prior VKA use or previous cerebrovascular events. Interactions were considered significant at p <0.05. Three studies (50,578 patients) were included, respectively evaluating apixaban, rivaroxaban, and dabigatran versus warfarin. A trend towards interaction with heart failure (p = 0.08) was observed with respect to SSE reduction, this being greater in patients not presenting heart failure (RR = 0.76 [0.67-0.86]) than in those with heart failure (RR = 0.90 [0.78-1.04]); Significant interaction (p = 0.01) with CHADS2 score was observed, NOAC achieving a greater reduction in bleeding risk in patients with a score of 0-1 (RR 0.67 CI 0.57-0.79) than in those with a score ≥2 (RR 0.85 CI 0.74-0.98). Comparison of MB in patients with (RR 0.97 CI 0.79-1.18) and without (RR 0.76 CI 0.65-0.88) diabetes mellitus showed a similar trend (p = 0.06). No other interactions were found. All subgroups derived benefit from NOA in terms of SSE or MB reduction.
CONCLUSIONS: NOAC appeared to be more effective and safer than VKA in reducing SSE or MB irrespective of patient comorbidities. Thromboembolism risk, evaluated by CHADS2 score and, to a lesser extent, diabetes mellitus modified the treatment effects of NOAC without complete loss of benefit with respect to MB reduction.
Mots-clé
Administration, Oral, Anticoagulants/administration & dosage, Anticoagulants/adverse effects, Atrial Fibrillation/drug therapy, Clinical Trials, Phase III as Topic/methods, Humans, Randomized Controlled Trials as Topic/methods, Safety
Pubmed
Web of science
Open Access
Oui
Création de la notice
23/12/2015 14:31
Dernière modification de la notice
20/08/2019 15:19
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