Novel oral anticoagulants for the secondary prevention of cerebral ischemia

A network meta-analysis

Aristeidis H. Katsanos, Dimitris Mavridis, John Parissis, Spyridon Deftereos, Alexandra Frogoudaki, Agathi Rosa Vrettou, Ignatios Ikonomidis, Maria Chondrogianni, Apostolos Safouris, Angeliki Filippatou, Konstantinos Voumvourakis, Nikos Triantafyllou, John Ellul, Theodore Karapanayiotides, Sotirios Giannopoulos, Anne Alexandrov, Andrei Alexandrov, Georgios Tsivgoulis

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Novel oral anticoagulants (NOACs) have shown to be both safe and effective for ischemic stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). We conducted a network meta-analysis (NMA) using published data from secondary prevention subgroups of different phase III randomized clinical trials (RCTs) comparing individual NOACs with warfarin. Methods: Eligible studies were identified by searching MEDLINE and SCOPUS and the Cochrane Central Register of Controlled Trials databases. First, we conducted a pairwise meta-analysis for each pairwise comparison, and then we performed NMA to combine direct and indirect evidence for any given pair of treatments. The comparative effects of all NOACs against warfarin were ranked with the surface under the cumulative ranking (SUCRA) curve for each outcome. Results: We identified four RCTs (including 15,240 patients) comparing individual NOACs (apixaban, dabigatran, rivaroxaban) with warfarin. Using indirect evidence, dabigatran was related to a significantly lower risk of hemorrhagic stroke compared with rivaroxaban [risk ratio (RR) 0.28; 95% confidence interval (CI) 0.11-0.75], while rivaroxaban was associated with a significantly lower risk of major gastrointestinal bleeding compared with dabigatran (RR 0.14; 95% CI 0.03-0.74). We also performed clustered ranking plot for the primary efficacy and safety endpoints to identify the treatment with the probably best benefit-to-risk ratio profile. Conclusions: The three NOACs showed differences in terms of safety and efficacy for secondary stroke prevention in NVAF. Our findings can serve only as hypothesis generation and require independent confirmation in head-to-head RCTs, owing to the sparse available evidence and increased uncertainty in both indirect effect estimates and ranking of treatments.

Original languageEnglish (US)
Pages (from-to)359-368
Number of pages10
JournalTherapeutic Advances in Neurological Disorders
Volume9
Issue number5
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

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Secondary Prevention
Brain Ischemia
Anticoagulants
Warfarin
Randomized Controlled Trials
Stroke
Odds Ratio
Atrial Fibrillation
Confidence Intervals
Safety
Phase III Clinical Trials
MEDLINE
Uncertainty
Meta-Analysis
Therapeutics
Network Meta-Analysis
Databases
Hemorrhage
Dabigatran
Rivaroxaban

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Neurology
  • Clinical Neurology

Cite this

Novel oral anticoagulants for the secondary prevention of cerebral ischemia : A network meta-analysis. / Katsanos, Aristeidis H.; Mavridis, Dimitris; Parissis, John; Deftereos, Spyridon; Frogoudaki, Alexandra; Vrettou, Agathi Rosa; Ikonomidis, Ignatios; Chondrogianni, Maria; Safouris, Apostolos; Filippatou, Angeliki; Voumvourakis, Konstantinos; Triantafyllou, Nikos; Ellul, John; Karapanayiotides, Theodore; Giannopoulos, Sotirios; Alexandrov, Anne; Alexandrov, Andrei; Tsivgoulis, Georgios.

In: Therapeutic Advances in Neurological Disorders, Vol. 9, No. 5, 01.09.2016, p. 359-368.

Research output: Contribution to journalArticle

Katsanos, AH, Mavridis, D, Parissis, J, Deftereos, S, Frogoudaki, A, Vrettou, AR, Ikonomidis, I, Chondrogianni, M, Safouris, A, Filippatou, A, Voumvourakis, K, Triantafyllou, N, Ellul, J, Karapanayiotides, T, Giannopoulos, S, Alexandrov, A, Alexandrov, A & Tsivgoulis, G 2016, 'Novel oral anticoagulants for the secondary prevention of cerebral ischemia: A network meta-analysis', Therapeutic Advances in Neurological Disorders, vol. 9, no. 5, pp. 359-368. https://doi.org/10.1177/1756285616659411
Katsanos, Aristeidis H. ; Mavridis, Dimitris ; Parissis, John ; Deftereos, Spyridon ; Frogoudaki, Alexandra ; Vrettou, Agathi Rosa ; Ikonomidis, Ignatios ; Chondrogianni, Maria ; Safouris, Apostolos ; Filippatou, Angeliki ; Voumvourakis, Konstantinos ; Triantafyllou, Nikos ; Ellul, John ; Karapanayiotides, Theodore ; Giannopoulos, Sotirios ; Alexandrov, Anne ; Alexandrov, Andrei ; Tsivgoulis, Georgios. / Novel oral anticoagulants for the secondary prevention of cerebral ischemia : A network meta-analysis. In: Therapeutic Advances in Neurological Disorders. 2016 ; Vol. 9, No. 5. pp. 359-368.
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AU - Katsanos, Aristeidis H.

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AU - Deftereos, Spyridon

AU - Frogoudaki, Alexandra

AU - Vrettou, Agathi Rosa

AU - Ikonomidis, Ignatios

AU - Chondrogianni, Maria

AU - Safouris, Apostolos

AU - Filippatou, Angeliki

AU - Voumvourakis, Konstantinos

AU - Triantafyllou, Nikos

AU - Ellul, John

AU - Karapanayiotides, Theodore

AU - Giannopoulos, Sotirios

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