Real-world evidence comparing oral anticoagulants for NVAF in Europe: a systematic review and network meta-analysis.

IF 1 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Future cardiology Pub Date : 2025-05-01 Epub Date: 2025-04-02 DOI:10.1080/14796678.2025.2484119

Allie Cichewicz, Shantanu Jawla, Priccila Zuchinali, Morodoluwa Akin-Fajiye, Daniela Massierer, Italo Porto, Xavier Garcia-Moll

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Abstract

Aim: Atrial fibrillation is the most commonly sustained cardiac arrhythmia, increasing the risk of stroke and systemic embolic events. This systematic review and network meta-analysis (NMA) aimed to compare real-world evidence (RWE) on the effectiveness and safety of edoxaban with other direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF) in Europe.

Materials & methods: Searches from January 2013 to December 2022 identified comparative observational studies assessing effectiveness/safety outcomes in patients with NVAF. Bayesian NMA estimated comparative effectiveness/safety of edoxaban with other DOACs and VKAs.

Results: The review identified 57 studies analyzing data from 24 unique databases; 33 studies were included in the base-case analyses. DOACs showed benefit over VKAs for most outcomes, of which major bleeding and all-cause mortality were most commonly reported. Edoxaban demonstrated a comparable effectiveness/safety profile to other DOACs and significantly reduced risk of major bleeding (hazard ratio [95% credible interval]: 0.67 [0.54, 0.84]) and intracranial hemorrhage (0.69 [0.51, 0.94]) versus rivaroxaban.

Conclusion: This NMA provides valuable insights into the real-world effectiveness and safety of DOACs and VKAs in Europe, supporting clinical decision-making and adding to the existing evidence base from clinical trials.

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比较欧洲口服抗凝剂治疗非瓣瓣性房颤的真实证据：系统回顾和网络荟萃分析。

目的：心房颤动是最常见的持续性心律失常，会增加中风和全身性栓塞事件的风险。本系统综述和网络荟萃分析（NMA）旨在比较埃多沙班与其他直接口服抗凝药（DOACs）和维生素 K 拮抗剂（VKAs）在欧洲非瓣膜性心房颤动（NVAF）患者中的有效性和安全性的真实世界证据（RWE）：从 2013 年 1 月至 2022 年 12 月进行检索，确定了评估 NVAF 患者有效性/安全性结果的比较观察性研究。贝叶斯NMA估计了埃多沙班与其他DOACs和VKAs的有效性/安全性比较：综述确定了 57 项研究，分析了来自 24 个独特数据库的数据；33 项研究纳入了基础案例分析。就大多数结果而言，DOACs 比 VKAs 更有疗效，其中最常报道的是大出血和全因死亡率。埃多沙班的有效性/安全性与其他 DOACs 相当，与利伐沙班相比，大出血（危险比[95% 可信区间]：0.67 [0.54, 0.84]）和颅内出血（0.69 [0.51, 0.94]）的风险显著降低：该 NMA 为了解 DOAC 和 VKAs 在欧洲的实际有效性和安全性提供了宝贵的信息，有助于临床决策，并补充了现有的临床试验证据基础。

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来源期刊

Future cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.80

自引率

5.90%

发文量

期刊介绍： Research advances have contributed to improved outcomes across all specialties, but the rate of advancement in cardiology has been exceptional. Concurrently, the population of patients with cardiac conditions continues to grow and greater public awareness has increased patients" expectations of new drugs and devices. Future Cardiology (ISSN 1479-6678) reflects this new era of cardiology and highlights the new molecular approach to advancing cardiovascular therapy. Coverage will also reflect the major technological advances in bioengineering in cardiology in terms of advanced and robust devices, miniaturization, imaging, system modeling and information management issues.