The study aimed to assess the risk of
myocardial infarction (MI) and
major adverse cardiac events during non-
vitamin K antagonist oral
anticoagulants (
NOAC) compared to
warfarin therapy in patients with
atrial fibrillation (AF), both treated and not treated with
percutaneous coronary interventions (PCI). In a systematic search, we selected eight randomized clinical trials with a total of 81,943 patients.
Dabigatran, compared to
warfarin, significantly increased the risk of MI (relative risk [RR] 1.38, 95% CI 1.14-1.67), while the FXa inhibitors' effect did not differ significantly from
warfarin (RR 0.96, 95% CI 0.86-1.09). The RR comparison between analyzed subgroups (
dabigatran vs. FXa inhibitors) showed a significant difference (Chi2 = 9.51, df = 1, p = 0.002). In a network meta-analysis,
dabigatran 110 mg b.i.d. increased the risk of MI compared to
warfarin,
apixaban,
edoxaban, and
rivaroxaban. Also,
dabigatran 150 mg b.i.d. increased the risk of MI compared to
warfarin,
apixaban, and
rivaroxaban. Moreover, we tried to estimate the treatment ranking of the best
therapy for MI prevention in patients with AF treated with PCI.
Rivaroxaban had a 90% probability of being ranked the best
therapy for MI prevention, whereas
dabigatran 110 mg had an 8.2% probability.
Dabigatran 150 mg was the most effective in
stroke prevention (94% probability). Each
NOAC is associated with a different risk of MI. Furthermore, we should consider FXa inhibitors as the first line NOACs in AF and
coronary artery disease patients. PROSPERO ID CRD42020179808.