1Consultant Systematic Review, Abacus International, Bicester, UK.
Clin Appl Thromb Hemost. 2013 Nov-Dec;19(6):619-31. doi: 10.1177/1076029613486539. Epub 2013 May 22.
The novel oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban have been recently indicated for stroke prevention in patients with atrial fibrillation (AF) . Due to a lack of direct head-to-head trials comparing the NOACs, the current systematic review and network meta-analysis (NMA) were conducted to assess their relative efficacy and safety. Three phase III randomized controlled trials enrolling 50 578 patients were included. Results of the NMA show a clear trend favoring NOACs over warfarin with regard to the key outcomes of stroke/systemic embolism and all-cause mortality, with apixaban also showing a favorable response for major bleeding and total discontinuations. Although there were few significant differences among the NOACS with regard to efficacy outcomes, apixaban and dabigatran 110 mg were associated with significantly lower hazards of major bleeding compared with dabigatran 150 mg and rivaroxaban. The NOACs offer a therapeutic advance over standard warfarin treatment in stoke prevention in patients with nonvalvular AF.
新型口服抗凝剂（NOACs）阿哌沙班、达比加群和利伐沙班最近被批准用于预防心房颤动（AF）患者的中风。由于缺乏直接比较 NOACs 的头对头试验，因此进行了这项系统评价和网络荟萃分析（NMA），以评估它们的相对疗效和安全性。纳入了三项纳入 50578 名患者的 III 期随机对照试验。NMA 的结果显示，NOACs 在中风/全身性栓塞和全因死亡率等关键结局方面明显优于华法林，阿哌沙班在大出血和总停药方面也有较好的反应。尽管在疗效结局方面，NOACs 之间几乎没有显著差异，但与达比加群 150mg 相比，阿哌沙班和达比加群 110mg 与主要出血风险显著降低相关，利伐沙班也与达比加群 150mg 相比与主要出血风险显著降低相关。NOACs 在预防非瓣膜性房颤患者中风方面提供了优于标准华法林治疗的治疗进展。
