Primary and secondary prevention with new oral anticoagulant drugs for stroke prevention in atrial fibrillation: indirect comparison analysis.

Abstract:

OBJECTIVE:To do an indirect comparison analysis of apixaban against dabigatran etexilate (2 doses) and rivaroxaban (1 dose), as well as of rivaroxaban against dabigatranetexilate (2 doses), for their relative efficacy and safety against each other, with particular focus on the secondary prevention population for stroke prevention in atrial fibrillation. A secondary objective was to do the same analysis in the primary prevention cohort. DESIGN:Indirect treatment comparisons of phase III clinical trials of stroke prevention in atrial fibrillation, with a focus on the secondary prevention cohorts. A secondary analysis was done on the primary prevention cohort. DATA SOURCES:Medline and Central (up to June 2012), clinical trials registers, conference proceedings, and websites of regulatory agencies. STUDY SELECTION:Randomised controlled trials of rivaroxaban, dabigatran, or apixaban compared with warfarin for stroke prevention in atrial fibrillation. RESULTS:In the secondary prevention (previous stroke) subgroup, when apixaban was compared with dabigatran (110 mg and 150 mg twice daily) for efficacy and safety endpoints, the only significant difference seen was less myocardial infarction (hazard ratio 0.39, 95% confidence interval 0.16 to 0.95) with apixaban compared with dabigatran 150 mg twice daily. No significant differences were seen in efficacy and most safety endpoints between apixaban or dabigatran 150 mg twice daily versus rivaroxaban. Less haemorrhagic stroke (hazard ratio 0.15, 0.03 to 0.66), vascular death (0.64, 0.42 to 0.99), major bleeding (0.68, 0.47 to 0.99), and intracranial bleeding (0.27, 0.10 to 0.73) were seen with dabigatran 110 mg twice daily versus rivaroxaban. In the primary prevention (no previous stroke) subgroup, apixaban was superior to dabigatran 110 mg twice daily for disabling or fatal stroke (hazard ratio 0.59, 0.36 to 0.97). Compared with dabigatran 150 mg twice daily, apixaban was associated with more stroke (hazard ratio 1.45, 1.01 to 2.08) and with less major bleeding (0.75, 0.60 to 0.94), gastrointestinal bleeding (0.61, 0.42 to 0.89), and other location bleeding (0.74, 0.58 to 0.94). Compared with rivaroxaban, dabigatran 110 mg twice daily was associated with more myocardial infarction events. No significant differences were seen for the main efficacy and safety endpoints between dabigatran 150 mg twice daily and rivaroxaban, or in efficacy endpoints between apixaban and rivaroxaban. Apixaban was associated with less major bleeding (hazard ratio 0.61, 0.48 to 0.78) than rivaroxaban. CONCLUSIONS:For secondary prevention, apixaban, rivaroxaban, and dabigatran had broadly similar efficacy for the main endpoints, although the endpoints of haemorrhagic stroke, vascular death, major bleeding, and intracranial bleeding were less common with dabigatran 110 mg twice daily than with rivaroxaban. For primary prevention, the three drugs showed some differences in relation to efficacy and bleeding. These results are hypothesis generating and should be confirmed in a head to head randomised trial.

journal_name

BMJ

authors

Rasmussen LH,Larsen TB,Graungaard T,Skjøth F,Lip GY

doi

10.1136/bmj.e7097

subject

Has Abstract

pub_date

2012-11-05 00:00:00

pages

e7097

eissn

0959-8138

issn

1756-1833

journal_volume

345

pub_type

杂志文章
  • Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study.

    abstract:OBJECTIVES:To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count <200 cells/mm(3) at start of antiretroviral therapy. DESIGN:Cohort study. SETTING:Outpatient HIV c...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.d6016

    authors: May M,Gompels M,Delpech V,Porter K,Post F,Johnson M,Dunn D,Palfreeman A,Gilson R,Gazzard B,Hill T,Walsh J,Fisher M,Orkin C,Ainsworth J,Bansi L,Phillips A,Leen C,Nelson M,Anderson J,Sabin C

    更新日期:2011-10-11 00:00:00

  • Low dose aspirin and cognitive function in the women's health study cognitive cohort.

    abstract:OBJECTIVE:To determine whether low dose aspirin protects women aged 65 or more against cognitive decline. DESIGN:Cohort study within both arms of the women's health study, a randomised, double blind, placebo controlled trial of low dose aspirin for the primary prevention of cardiovascular disease and cancer, 1992-5. ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,随机对照试验

    doi:10.1136/bmj.39166.597836.BE

    authors: Kang JH,Cook N,Manson J,Buring JE,Grodstein F

    更新日期:2007-05-12 00:00:00

  • Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome.

    abstract:OBJECTIVE:To study the dynamic function of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome. DESIGN:Prospective comparison of patients with postviral fatigue syndrome with two control groups. SETTING:Department of neurology, University of Glasgow, Southern General Hospital; depar...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.304.6833.1010

    authors: Bakheit AM,Behan PO,Dinan TG,Gray CE,O'Keane V

    更新日期:1992-04-18 00:00:00

  • Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase.

    abstract:OBJECTIVE:To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in med...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.d199

    authors: Benning A,Dixon-Woods M,Nwulu U,Ghaleb M,Dawson J,Barber N,Franklin BD,Girling A,Hemming K,Carmalt M,Rudge G,Naicker T,Kotecha A,Derrington MC,Lilford R

    更新日期:2011-02-03 00:00:00

  • Physiotherapy intervention late after stroke and mobility.

    abstract:OBJECTIVE:To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke. DESIGN:Randomised crossover trial comparing two groups offered intervention by a physiotherapist, one immediately after entry into the trial and the other after a delay of three mont...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.304.6827.609

    authors: Wade DT,Collen FM,Robb GF,Warlow CP

    更新日期:1992-03-07 00:00:00

  • Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis.

    abstract:OBJECTIVE:To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Randomised controlled trials involving a threshold for red blood cell transfusion in hospita...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.i1351

    authors: Docherty AB,O'Donnell R,Brunskill S,Trivella M,Doree C,Holst L,Parker M,Gregersen M,Pinheiro de Almeida J,Walsh TS,Stanworth SJ

    更新日期:2016-03-29 00:00:00

  • Run an emergency helpline.

    abstract::Telephone helplines are an effective way of dealing with health related incidents in which large numbers of people need personal counselling or information for reassurance or case finding. Helplines often have to be set up at short notice, which is labour intensive and makes recruitment of appropriate staff difficult....

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.309.6946.44

    authors: Stark C,Christie P,Marr AC

    更新日期:1994-07-02 00:00:00

  • Differences in mortality after fracture of hip: the east Anglian audit.

    abstract:OBJECTIVE:To investigate differences between hospitals in clinical management of patients admitted with fractured hip and to relate these to mortality at 90 days. DESIGN:A prospective audit of process and outcome of care based on interviews with patients, abstraction from records with standard proforma, and follow up ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.310.6984.904

    authors: Todd CJ,Freeman CJ,Camilleri-Ferrante C,Palmer CR,Hyder A,Laxton CE,Parker MJ,Payne BV,Rushton N

    更新日期:1995-04-08 00:00:00

  • Heat and risk of myocardial infarction: hourly level case-crossover analysis of MINAP database.

    abstract:OBJECTIVE:To quantify the association between exposure to higher temperatures and the risk of myocardial infarction at an hourly temporal resolution. DESIGN:Case-crossover study. SETTING:England and Wales Myocardial Ischaemia National Audit Project (MINAP) database. PARTICIPANTS:24,861 hospital admissions for myocar...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.e8050

    authors: Bhaskaran K,Armstrong B,Hajat S,Haines A,Wilkinson P,Smeeth L

    更新日期:2012-12-13 00:00:00

  • Scenario analysis of the future of medicines.

    abstract::Planning future policy for medicines poses difficult problems. The main players in the drug business have their own views as to how the world around them functions and how the future of medicines should be shaped. In this paper we show how a scenario analysis can provide a powerful teaching device to readjust peoples'...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.309.6962.1137

    authors: Leufkens H,Haaijer-Ruskamp F,Bakker A,Dukes G

    更新日期:1994-10-29 00:00:00

  • Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation.

    abstract:OBJECTIVE:To determine whether the novel avian influenza H7N9 virus can transmit from person to person and its efficiency. DESIGN:Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in March 2013. SETTING:Wuxi, Eastern China. PARTICIPANTS:Two patients, their close contacts...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.f4752

    authors: Qi X,Qian YH,Bao CJ,Guo XL,Cui LB,Tang FY,Ji H,Huang Y,Cai PQ,Lu B,Xu K,Shi C,Zhu FC,Zhou MH,Wang H

    更新日期:2013-08-06 00:00:00

  • Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial.

    abstract:OBJECTIVE:To determine whether cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at risk for serious conditions such as schizophrenia. DESIGN:Multisite single blind randomised controlled trial. SETTING:Diverse services at fi...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.e2233

    authors: Morrison AP,French P,Stewart SL,Birchwood M,Fowler D,Gumley AI,Jones PB,Bentall RP,Lewis SW,Murray GK,Patterson P,Brunet K,Conroy J,Parker S,Reilly T,Byrne R,Davies LM,Dunn G

    更新日期:2012-04-05 00:00:00

  • Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis.

    abstract:OBJECTIVE:To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. DESIGN:Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. SETTING:Nine t...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.325.7358.246

    authors: Fulop N,Protopsaltis G,Hutchings A,King A,Allen P,Normand C,Walters R

    更新日期:2002-08-03 00:00:00

  • Cost effectiveness of strategies to combat road traffic injuries in sub-Saharan Africa and South East Asia: mathematical modelling study.

    abstract:OBJECTIVE:To identify and estimate the population costs and effects of a selected set of enforcement strategies for reducing the burden of road traffic injuries in developing countries. DESIGN:Cost effectiveness analysis based on an epidemiological model. SETTING:Two epidemiologically defined World Health Organizatio...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.e612

    authors: Chisholm D,Naci H,Hyder AA,Tran NT,Peden M

    更新日期:2012-03-02 00:00:00

  • The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study.

    abstract:OBJECTIVES:To examine the risk of atrial fibrillation in relation to the whole spectrum of thyroid function in a large cohort of patients. DESIGN:Population based cohort study of general practice patients identified by linkage of nationwide registries at the individual level. SETTING:Primary care patients in the city...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.e7895

    authors: Selmer C,Olesen JB,Hansen ML,Lindhardsen J,Olsen AM,Madsen JC,Faber J,Hansen PR,Pedersen OD,Torp-Pedersen C,Gislason GH

    更新日期:2012-11-27 00:00:00

  • Differences in mortality and morbidity in African Caribbean and European people with non-insulin dependent diabetes mellitus: results of 20 year follow up of a London cohort of a multinational study.

    abstract:OBJECTIVE:To examine differences in morbidity and mortality due to non-insulin dependent diabetes in African Caribbeans and Europeans. DESIGN:Cohort study of patients with non-insulin dependent diabetes drawn from diabetes clinics in London. Baseline investigations were performed in 1975-7; follow up continued until 1...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.313.7061.848

    authors: Chaturvedi N,Jarrett J,Morrish N,Keen H,Fuller JH

    更新日期:1996-10-05 00:00:00

  • Uptake of systematic reviews and meta-analyses based on individual participant data in clinical practice guidelines: descriptive study.

    abstract:OBJECTIVE:To establish the extent to which systematic reviews and meta-analyses of individual participant data (IPD) are being used to inform the recommendations included in published clinical guidelines. DESIGN:Descriptive study. SETTING:Database maintained by the Cochrane IPD Meta-analysis Methods Group, supplement...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.h1088

    authors: Vale CL,Rydzewska LH,Rovers MM,Emberson JR,Gueyffier F,Stewart LA,Cochrane IPD Meta-analysis Methods Group.

    更新日期:2015-03-06 00:00:00

  • Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study.

    abstract:OBJECTIVE:To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. DESIGN:Prospective cohort study. SETTING:28 hospitals in the Netherlands and Belgium. PARTICIPANTS:1920 consecutive women treated with toc...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.b744

    authors: de Heus R,Mol BW,Erwich JJ,van Geijn HP,Gyselaers WJ,Hanssens M,Härmark L,van Holsbeke CD,Duvekot JJ,Schobben FF,Wolf H,Visser GH

    更新日期:2009-03-05 00:00:00

  • Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action.

    abstract:OBJECTIVE:To investigate the effects of spinal cord stimulation on myocardial ischaemia, coronary blood flow, and myocardial oxygen consumption in angina pectoris induced by atrial pacing. DESIGN:The heart was paced to angina during a control phase and treatment with spinal cord stimulation. Blood samples were drawn f...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.307.6902.477

    authors: Mannheimer C,Eliasson T,Andersson B,Bergh CH,Augustinsson LE,Emanuelsson H,Waagstein F

    更新日期:1993-08-21 00:00:00

  • Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries.

    abstract:OBJECTIVE:To assess the costs and health effects of a range of interventions for preventing the spread of HIV and for treating people with HIV/AIDS in the context of the millennium development goal for combating HIV/AIDS. DESIGN:Cost effectiveness analysis based on an epidemiological model. SETTING:Analyses undertake...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.38643.368692.68

    authors: Hogan DR,Baltussen R,Hayashi C,Lauer JA,Salomon JA

    更新日期:2005-12-17 00:00:00

  • Randomised controlled trial comparing oral and intravenous rehydration therapy in children with diarrhoea.

    abstract:OBJECTIVE:To determine the effectiveness of oral rehydration in children with moderate dehydration caused by gastroenteritis, and to compare the complications of oral and intravenous treatment. DESIGN:Randomised controlled trial. SETTING:Emergency department and infectious diseases ward in a large urban teaching hosp...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.303.6799.393

    authors: Mackenzie A,Barnes G

    更新日期:1991-08-17 00:00:00

  • Referrals from general practice to hospital outpatient departments: a strategy for improvement.

    abstract:OBJECTIVE:To determine the appropriateness of referrals from general practice to hospital outpatient departments. DESIGN:Prospective audit of referrals from a group practice over one year. SETTING:Six handed practice in a southern coastal town. SUBJECTS:All patients referred during the study period for whom a copy o...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.299.6701.722

    authors: Emmanuel J,Walter N

    更新日期:1989-09-16 00:00:00

  • Accuracy of UK Rapid Test Consortium (UK-RTC) "AbC-19 Rapid Test" for detection of previous SARS-CoV-2 infection in key workers: test accuracy study.

    abstract:OBJECTIVE:To assess the accuracy of the AbC-19 Rapid Test lateral flow immunoassay for the detection of previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN:Test accuracy study. SETTING:Laboratory based evaluation. PARTICIPANTS:2847 key workers (healthcare staff, fire and rescue of...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.m4262

    authors: Mulchandani R,Jones HE,Taylor-Phillips S,Shute J,Perry K,Jamarani S,Brooks T,Charlett A,Hickman M,Oliver I,Kaptoge S,Danesh J,Di Angelantonio E,Ades AE,Wyllie DH,EDSAB-HOME and COMPARE Investigators.

    更新日期:2020-11-11 00:00:00

  • Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study.

    abstract:OBJECTIVE:To evaluate the impact of the US Air Force suicide prevention programme on risk of suicide and other outcomes that share underlying risk factors. DESIGN:Cohort study with quasi-experimental design and analysis of cohorts before (1990-6) and after (1997-2002) the intervention. PARTICIPANTS:5,260,292 US Air F...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.327.7428.1376

    authors: Knox KL,Litts DA,Talcott GW,Feig JC,Caine ED

    更新日期:2003-12-13 00:00:00

  • Equity in access to total joint replacement of the hip and knee in England: cross sectional study.

    abstract:OBJECTIVE:To explore geographical and sociodemographic factors associated with variation in equity in access to total hip and knee replacement surgery. DESIGN:Combining small area estimates of need and provision to explore equity in access to care. SETTING:English census wards. SUBJECTS:Patients throughout England w...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.c4092

    authors: Judge A,Welton NJ,Sandhu J,Ben-Shlomo Y

    更新日期:2010-08-11 00:00:00

  • Large outbreak of food poisoning caused by Salmonella typhimurium definitive type 49 in mayonnaise.

    abstract::An investigation was conducted to determine the vehicle of infection of an outbreak of food poisoning in a large metropolitan building early in 1988. A questionnaire was distributed to 700 people who had eaten in the building during the week of the outbreak, and attack rates for specific food were calculated. Food and...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.298.6666.99

    authors: Mitchell E,O'Mahony M,Lynch D,Ward LR,Rowe B,Uttley A,Rogers T,Cunningham DG,Watson R

    更新日期:1989-01-14 00:00:00

  • Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review.

    abstract:OBJECTIVE:To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. DESIGN:Systematic review and meta-analysis of randomised trials, q...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.c2332

    authors: Hopley C,Stengel D,Ekkernkamp A,Wich M

    更新日期:2010-06-11 00:00:00

  • Madness and care in the community: a medieval perspective.

    abstract::Care in the community for insane people today is more a matter of expert provision than communal support. In consequence, although they are no longer confined to hospital, mentally ill people largely remain marginalised in a society that does not have the resources, nor often the inclination, to take responsibility fo...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 历史文章,杂志文章

    doi:10.1136/bmj.311.7021.1708

    authors: Roffe D,Roffe C

    更新日期:1995-12-23 00:00:00

  • Epilepsy and pregnancy.

    abstract::According to a London physician, women with epilepsy taking antiepileptic drugs can take combined oral contraceptives (OCs). It is usual to recommend a combined OC preparation containing at least 50 mcg of estrogen (Ovran) from patients taking enzyme-inducing antiepileptic drugs; this can be increased to 60 mcg by ta...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.307.6902.492

    authors: O'Brien MD,Gilmour-White S

    更新日期:1993-08-21 00:00:00

  • The demand for neonatal intensive care.

    abstract::In a one year prospective study within the Trent Regional Health Authority the demand for neonatal intensive care was estimated to be 1.1 cots per 1000 births. Intensive care level 1 (as defined by the British Paediatric Association and British Association for Perinatal Paediatrics) was determined by two separate tech...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.299.6711.1305

    authors: Field DJ,Hodges S,Mason E,Burton P,Yates J,Wale S

    更新日期:1989-11-25 00:00:00