Abstract | AIMS: METHODS AND RESULTS: A systematic review and meta-analysis was performed using PubMed to search for non- vitamin K antagonist oral anticoagulant ( NOAC)-based randomized clinical trials. Data on subgroups of ACS or elective PCI were obtained by published reports or trial investigators. A total of 10 193 patients from four NOAC trials were analysed, of whom 5675 presenting with ACS (DAT = 3063 vs. TAT = 2612) and 4518 with stable coronary artery disease (SCAD; DAT = 2421 vs. TAT = 2097). The primary safety endpoint of ISTH major bleeding or clinically relevant non-major bleeding was reduced with DAT compared with TAT in both ACS (12.2% vs. 19.4%; RR 0.63, 95% CI 0.56-0.71; P < 0.0001; I2 = 0%) and SCAD (14.6% vs. 22.0%; RR 0.68, 95% CI 0.55-0.85; P = 0.0008; I2 = 66%), without interaction (P-int = 0.54). Findings were consistent for secondary bleeding endpoints, including intra-cranial haemorrhage. In both subgroups, there was no difference between DAT and TAT for all-cause death, major adverse cardiovascular events, or stroke. Myocardial infarction and stent thrombosis were numerically higher with DAT vs. TAT consistently in ACS and SCAD (P-int = 0.60 and 0.86, respectively). Findings were confirmed by multiple sensitivity analyses, including a separate analysis on dabigatran regimens and a restriction to PCI population. CONCLUSIONS: DAT, compared with TAT, is associated with lower bleeding risks, including intra-cranial haemorrhage, and a small non-significant excess of cardiac ischaemic events in both patients with or without ACS.
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Authors | Giuseppe Gargiulo, Christopher P Cannon, Charles Michael Gibson, Andreas Goette, Renato D Lopes, Jonas Oldgren, Serge Korjian, Stephan Windecker, Giovanni Esposito, Pascal Vranckx, Marco Valgimigli |
Journal | European heart journal. Cardiovascular pharmacotherapy
(Eur Heart J Cardiovasc Pharmacother)
Vol. 7
Issue FI1
Pg. f50-f60
(04 09 2021)
ISSN: 2055-6845 [Electronic] England |
PMID | 33119069
(Publication Type: Journal Article, Meta-Analysis, Systematic Review)
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Copyright | © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. |
Chemical References |
- Anticoagulants
- Fibrinolytic Agents
- Platelet Aggregation Inhibitors
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Topics |
- Acute Coronary Syndrome
(complications, diagnosis, therapy)
- Anticoagulants
(adverse effects)
- Atrial Fibrillation
(complications, diagnosis, drug therapy)
- Fibrinolytic Agents
(adverse effects)
- Humans
- Percutaneous Coronary Intervention
(adverse effects, methods)
- Platelet Aggregation Inhibitors
(adverse effects)
- Randomized Controlled Trials as Topic
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