Effectiveness and Safety of Apixaban in over 3.9 Million People with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Buckley, Benjamin JR ORCID: 0000-0002-1479-8872, Lane, Deirdre A ORCID: 0000-0002-5604-9378, Calvert, Peter, Zhang, Juqian ORCID: 0000-0002-9653-8635, Gent, David ORCID: 0000-0002-0365-913X, Mullins, C Daniel, Dorian, Paul, Kohsaka, Shun, Hohnloser, Stefan H and Lip, Gregory YH ORCID: 0000-0002-7566-1626
(2022) Effectiveness and Safety of Apixaban in over 3.9 Million People with Atrial Fibrillation: A Systematic Review and Meta-Analysis. JOURNAL OF CLINICAL MEDICINE, 11 (13). 3788-.

[img] Text
jcm-11-03788.pdf - Published version

Download (2MB) | Preview


<h4>Background</h4>There is a plethora of real-world data on the safety and effectiveness of direct-acting oral anticoagulants (DOACs); however, study heterogeneity has contributed to inconsistent findings. We compared the effectiveness and safety of apixaban with those of other direct-acting oral anticoagulants (DOACs) and vitamin K antagonists (VKA e.g., warfarin).<h4>Methods</h4>A systematic review and meta-analysis was conducted retrieving data from PubMed, SCOPUS and Web of Science from January 2009 to December 2021. Studies that evaluated apixaban (intervention) prescribed for adults (aged 18 years or older) with AF for stroke prevention compared to other DOACs or VKAs were identified. Primary outcomes included stroke/systemic embolism (SE), all-cause mortality, and major bleeding. Secondary outcomes were intracranial haemorrhage (ICH) and ischaemic stroke. Randomised controlled trials and non-randomised trials were considered for inclusion.<h4>Results</h4>In total, 67 studies were included, and 38 studies were meta-analysed. Participants taking apixaban had significantly lower stroke/SE compared to patients taking VKAs (relative risk (RR) 0.77, 95% confidence interval (CI) 0.64-0.93, I<sup>2</sup> = 94%) and dabigatran (RR 0.84, 95% CI 0.74-0.95, I<sup>2</sup> = 66%), but not to patients administered rivaroxaban. There was no statistical difference in mortality between apixaban and VKAs or apixaban and dabigatran. Compared to patients administered rivaroxaban, participants taking apixaban had lower mortality rates (RR 0.83, 95% CI 0.71-0.96, I<sup>2</sup> = 96%). Apixaban was associated with a significantly lower risk of major bleeding compared to VKAs (RR 0.58, 95% CI 0.52-0.65, I<sup>2</sup> = 90%), dabigatran (RR 0.79, 95% CI 0.70-0.88, I<sup>2</sup> = 78%) and rivaroxaban (RR 0.61, 95% CI 0.53-0.70, I<sup>2</sup> = 87%).<h4>Conclusions</h4>Apixaban was associated with a better overall safety and effectiveness profile compared to VKAs and other DOACs.

Item Type: Article
Uncontrolled Keywords: apixaban, atrial fibrillation, stroke, major bleeding, anticoagulant, secondary prevention
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 30 Jun 2022 14:54
Last Modified: 18 Jan 2023 20:56
DOI: 10.3390/jcm11133788
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3157518