The advantage for DOACs is clear, but the absolute benefit is small.
The evidence to support direct oral anticoagulants (DOACs) for patients in atrial fibrillation is quite strong, and yet many patients persist on warfarin. To consolidate and summarize the evidence, investigators from the major trials comparing DOACs with warfarin conducted a comprehensive patient-level network meta-analysis. They also tested for interactions by age and sex.
The analysis included data from 71,683 participants (median age, 72 years; 37% women) of the four pivotal industry-funded trials of DOACs versus warfarin (RE-LY, ROCKET AF, ARISTOTLE, ENGAGE AF-TIMI 48). The primary efficacy outcome was a composite of stroke of any type or systolic embolism, and the primary safety outcome was major bleeding. Results were as follows:
Reviewing Author
DisclosuresConsultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime
EquityHugo Health; Refactor Health; Element Science
Grant/Research SupportPfizer; Agency for Healthcare Research and Quality; Janssen Research and Development, National Institute of Biomedical Imaging and Engineering; National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; National Cancer Institute; American Heart Association
DisclosuresConsultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime
EquityHugo Health; Refactor Health; Element Science
Grant/Research SupportPfizer; Agency for Healthcare Research and Quality; Janssen Research and Development, National Institute of Biomedical Imaging and Engineering; National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; National Cancer Institute; American Heart Association