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Comparative coronary risks of apixaban, rivaroxaban and dabigatran: a meta‐analysis and adjusted indirect comparison
Author(s) -
Loke Yoon K.,
Pradhan Shiva,
Yeong Jessica Kayan,
Kwok Chun Shing
Publication year - 2014
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12376
Subject(s) - apixaban , dabigatran , medicine , rivaroxaban , acute coronary syndrome , vitamin k antagonist , myocardial infarction , randomized controlled trial , placebo , warfarin , atrial fibrillation , alternative medicine , pathology
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.