Please use this identifier to cite or link to this item: http://buratest.brunel.ac.uk/handle/2438/11027
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dc.contributor.authorCameron, C-
dc.contributor.authorCoyle, D-
dc.contributor.authorRichter, T-
dc.contributor.authorKelly, S-
dc.contributor.authorGauthier, K-
dc.contributor.authorSteiner, S-
dc.contributor.authorCarrier, M-
dc.contributor.authorCoyle, K-
dc.contributor.authorBai, A-
dc.contributor.authorMoulton, K-
dc.contributor.authorClifford, T-
dc.contributor.authorWells, G-
dc.date.accessioned2015-06-17T10:55:30Z-
dc.date.available2014-
dc.date.available2015-06-17T10:55:30Z-
dc.date.issued2014-
dc.identifier.citationBMJ Open, 4(6): e004301, (2014)en_US
dc.identifier.issn2044-6055-
dc.identifier.urihttp://bmjopen.bmj.com/content/4/6/e004301-
dc.identifier.urihttp://bura.brunel.ac.uk/handle/2438/11027-
dc.description.abstractObjective: To examine the comparative efficacy and safety of antithrombotic treatments (apixaban, dabigatran, edoxaban, rivaroxaban and vitamin K antagonists (VKA) at a standard adjusted dose (target international normalised ratio 2.0-3.0), acetylsalicylic acid (ASA), ASA and clopidogrel) for non-valvular atrial fibrillation and among subpopulations. Design: Systematic review and network meta-analysis. Data sources: A systematic literature search strategy was designed and carried out using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and the grey literature including the websites of regulatory agencies and health technology assessment organisations for trials published in English from 1988 to January 2014. Eligibility criteria for selecting studies: Randomised controlled trials were selected for inclusion if they were published in English, included at least one antithrombotic treatment and involved patients with non-valvular atrial fibrillation eligible to receive anticoagulant therapy. Results: For stroke or systemic embolism, dabigatran 150 mg and apixaban twice daily were associated with reductions relative to standard adjusted dose VKA, whereas low-dose ASA and the combination of clopidogrel plus low-dose ASA were associated with increases. Absolute risk reductions ranged from 6 fewer events per 1000 patients treated for dabigatran 150 mg twice daily to 15 more events for clopidogrel plus ASA. For major bleeding, edoxaban 30 mg daily, apixaban, edoxaban 60 mg daily and dabigatran 110 mg twice daily were associated with reductions compared to standard adjusted dose VKA. Absolute risk reductions with these agents ranged from 18 fewer per 1000 patients treated each year for edoxaban 30 mg daily to 24 more for medium dose ASA. Conclusions: Compared with standard adjusted dose VKA, new oral anticoagulants were associated with modest reductions in the absolute risk of stroke and major bleeding. People on antiplatelet drugs experienced more strokes compared with anticoagulant drugs without any reduction in bleeding risk. To fully elucidate the comparative benefits and harms of antithrombotic agents across the various subpopulations, rigorously conducted comparative studies or network meta-regression analyses of patientlevel data are required. Systematic review registration number: PROSPERO registry-CRD42012002721.en_US
dc.description.sponsorshipThis research was supported through a grant from the Canadian Institute of Health Research (CIHR) Drug Safety and Effectiveness Network (Funding reference number – 116573) and received financial support from the Canadian Agency for Drugs and Technologies in Health. CC is a recipient of a Vanier Canada Graduate Scholarship through CIHR (Funding reference number – CGV 121171) and has received funding from Canadian Network and Centre for Trials Internationally (CANNeCTIN). He is also a trainee on the CIHR Drug Safety and Effectiveness Network team grant (Funding reference number – 116573). MC is a recipient of a New Investigator Award from the Heart and Stroke Foundation of Canada and holds a T2 research chair in cancer and thrombosis from the University of Ottawa.en_US
dc.languageeng-
dc.language.isoenen_US
dc.publisherBMJ Publishing Groupen_US
dc.subjectAntithrombotic treatmentsen_US
dc.subjectStrokeen_US
dc.subjectMajor bleedingen_US
dc.subjectAtrial fibrillationen_US
dc.subjectAntithrombotic agentsen_US
dc.titleSystematic review and network meta-analysis comparing antithrombotic agents for the prevention of stroke and major bleeding in patients with atrial fibrillationen_US
dc.typeArticleen_US
dc.identifier.doihttp://dx.doi.org/10.1136/bmjopen-2013-004301-
dc.relation.isPartOfBMJ Open-
pubs.issue6-
pubs.issue6-
pubs.volume4-
pubs.volume4-
Appears in Collections:Health Economics Research Group (HERG)

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