AIMS: There are concerns regarding increased risk of acute coronary syndrome with dabigatran. We aimed to assess whether alternative treatment options such as rivaroxaban or apixaban carry a similar risk as compared with dabigatran. METHODS: We searched MEDLINE and EMBASE for randomized controlled trials of apixaban, dabigatran or rivaroxaban against control (placebo, heparin or vitamin K antagonist). We pooled odds ratios (OR) for adverse coronary events (acute coronary syndrome or myocardial infarction) using fixed effect meta-analysis and assessed heterogeneity with I(2) . We conducted adjusted indirect comparisons to compare risk of adverse coronary events with apixaban or rivaroxaban vs. dabigatran. RESULTS: Twenty-seven randomized controlled trials met the inclusion criteria. Dabigatran was associated with a significantly increased risk of adverse coronary events in pooled analysis of nine trials (OR 1.45, 95% CI 1.14, 1.86). There was no signal for coronary risk with apixaban from nine trials (pooled OR 0.89, 95% CI 0.78, 1.03) or rivaroxaban from nine trials (pooled OR 0.81, 95% CI 0.72, 0.93). Overall, adjusted indirect comparison suggested that both apixaban (OR 0.61, 95% CI 0.44, 0.85) and rivaroxaban (OR 0.54; 95% CI 0.39, 0.76) were associated with lower coronary risk than dabigatran. Restricting the indirect comparison to a vitamin K antagonist as a common control, yielded similar findings, OR 0.57 (95% CI 0.39, 0.85) for apixaban vs. dabigatran and 0.53 (95% CI 0.37, 0.77) for rivaroxaban vs. dabigatran. CONCLUSIONS: There are significant differences in the comparative safety of apixaban, rivaroxaban and dabigatran with regards to acute coronary adverse events.
AIMS: There are concerns regarding increased risk of acute coronary syndrome with dabigatran. We aimed to assess whether alternative treatment options such as rivaroxaban or apixaban carry a similar risk as compared with dabigatran. METHODS: We searched MEDLINE and EMBASE for randomized controlled trials of apixaban, dabigatran or rivaroxaban against control (placebo, heparin or vitamin K antagonist). We pooled odds ratios (OR) for adverse coronary events (acute coronary syndrome or myocardial infarction) using fixed effect meta-analysis and assessed heterogeneity with I(2) . We conducted adjusted indirect comparisons to compare risk of adverse coronary events with apixaban or rivaroxaban vs. dabigatran. RESULTS: Twenty-seven randomized controlled trials met the inclusion criteria. Dabigatran was associated with a significantly increased risk of adverse coronary events in pooled analysis of nine trials (OR 1.45, 95% CI 1.14, 1.86). There was no signal for coronary risk with apixaban from nine trials (pooled OR 0.89, 95% CI 0.78, 1.03) or rivaroxaban from nine trials (pooled OR 0.81, 95% CI 0.72, 0.93). Overall, adjusted indirect comparison suggested that both apixaban (OR 0.61, 95% CI 0.44, 0.85) and rivaroxaban (OR 0.54; 95% CI 0.39, 0.76) were associated with lower coronary risk than dabigatran. Restricting the indirect comparison to a vitamin K antagonist as a common control, yielded similar findings, OR 0.57 (95% CI 0.39, 0.85) for apixaban vs. dabigatran and 0.53 (95% CI 0.37, 0.77) for rivaroxaban vs. dabigatran. CONCLUSIONS: There are significant differences in the comparative safety of apixaban, rivaroxaban and dabigatran with regards to acute coronary adverse events.
Authors: Michael Rud Lassen; Alexander Gallus; Gary E Raskob; Graham Pineo; Dalei Chen; Luz Margarita Ramirez Journal: N Engl J Med Date: 2010-12-23 Impact factor: 91.245
Authors: Christopher B Granger; John H Alexander; John J V McMurray; Renato D Lopes; Elaine M Hylek; Michael Hanna; Hussein R Al-Khalidi; Jack Ansell; Dan Atar; Alvaro Avezum; M Cecilia Bahit; Rafael Diaz; J Donald Easton; Justin A Ezekowitz; Greg Flaker; David Garcia; Margarida Geraldes; Bernard J Gersh; Sergey Golitsyn; Shinya Goto; Antonio G Hermosillo; Stefan H Hohnloser; John Horowitz; Puneet Mohan; Petr Jansky; Basil S Lewis; Jose Luis Lopez-Sendon; Prem Pais; Alexander Parkhomenko; Freek W A Verheugt; Jun Zhu; Lars Wallentin Journal: N Engl J Med Date: 2011-08-27 Impact factor: 91.245
Authors: Stuart J Connolly; John Eikelboom; Campbell Joyner; Hans-Christoph Diener; Robert Hart; Sergey Golitsyn; Greg Flaker; Alvaro Avezum; Stefan H Hohnloser; Rafael Diaz; Mario Talajic; Jun Zhu; Prem Pais; Andrzej Budaj; Alexander Parkhomenko; Petr Jansky; Patrick Commerford; Ru San Tan; Kui-Hian Sim; Basil S Lewis; Walter Van Mieghem; Gregory Y H Lip; Jae Hyung Kim; Fernando Lanas-Zanetti; Antonio Gonzalez-Hermosillo; Antonio L Dans; Muhammad Munawar; Martin O'Donnell; John Lawrence; Gayle Lewis; Rizwan Afzal; Salim Yusuf Journal: N Engl J Med Date: 2011-02-10 Impact factor: 91.245
Authors: Sam Schulman; Clive Kearon; Ajay K Kakkar; Patrick Mismetti; Sebastian Schellong; Henry Eriksson; David Baanstra; Janet Schnee; Samuel Z Goldhaber Journal: N Engl J Med Date: 2009-12-10 Impact factor: 91.245
Authors: Michael R Lassen; Walter Ageno; Lars C Borris; Jay R Lieberman; Nadia Rosencher; Tiemo J Bandel; Frank Misselwitz; Alexander G G Turpie Journal: N Engl J Med Date: 2008-06-26 Impact factor: 91.245
Authors: Michael Rud Lassen; Gary E Raskob; Alexander Gallus; Graham Pineo; Dalei Chen; Ronald J Portman Journal: N Engl J Med Date: 2009-08-06 Impact factor: 91.245
Authors: Bengt I Eriksson; Ola E Dahl; Nadia Rosencher; Andreas A Kurth; C Niek van Dijk; Simon P Frostick; Martin H Prins; Rohan Hettiarachchi; Stefan Hantel; Janet Schnee; Harry R Büller Journal: Lancet Date: 2007-09-15 Impact factor: 79.321
Authors: Michael B Streiff; Giancarlo Agnelli; Jean M Connors; Mark Crowther; Sabine Eichinger; Renato Lopes; Robert D McBane; Stephan Moll; Jack Ansell Journal: J Thromb Thrombolysis Date: 2016-01 Impact factor: 2.300