Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis
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 ra...
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| Autor*in: |
Aristeidis H. Katsanos [verfasserIn] Dimitris Mavridis [verfasserIn] John Parissis [verfasserIn] Spyridon Deftereos [verfasserIn] Alexandra Frogoudaki [verfasserIn] Agathi-Rosa Vrettou [verfasserIn] Ignatios Ikonomidis [verfasserIn] Maria Chondrogianni [verfasserIn] Apostolos Safouris [verfasserIn] Angeliki Filippatou [verfasserIn] Konstantinos Voumvourakis [verfasserIn] Nikos Triantafyllou [verfasserIn] John Ellul [verfasserIn] Theodore Karapanayiotides [verfasserIn] Sotirios Giannopoulos [verfasserIn] Anne W. Alexandrov [verfasserIn] Andrei V. Alexandrov [verfasserIn] Georgios Tsivgoulis [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2016 |
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| Übergeordnetes Werk: |
In: Therapeutic Advances in Neurological Disorders - SAGE Publishing, 2018, 9(2016) |
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| Übergeordnetes Werk: |
volume:9 ; year:2016 |
| Links: |
Link aufrufen |
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| DOI / URN: |
10.1177/1756285616659411 |
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| Katalog-ID: |
DOAJ073633798 |
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| 520 | |a 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. | ||
| 653 | 0 | |a Neurology. Diseases of the nervous system | |
| 700 | 0 | |a Dimitris Mavridis |e verfasserin |4 aut | |
| 700 | 0 | |a John Parissis |e verfasserin |4 aut | |
| 700 | 0 | |a Spyridon Deftereos |e verfasserin |4 aut | |
| 700 | 0 | |a Alexandra Frogoudaki |e verfasserin |4 aut | |
| 700 | 0 | |a Agathi-Rosa Vrettou |e verfasserin |4 aut | |
| 700 | 0 | |a Ignatios Ikonomidis |e verfasserin |4 aut | |
| 700 | 0 | |a Maria Chondrogianni |e verfasserin |4 aut | |
| 700 | 0 | |a Apostolos Safouris |e verfasserin |4 aut | |
| 700 | 0 | |a Angeliki Filippatou |e verfasserin |4 aut | |
| 700 | 0 | |a Konstantinos Voumvourakis |e verfasserin |4 aut | |
| 700 | 0 | |a Nikos Triantafyllou |e verfasserin |4 aut | |
| 700 | 0 | |a John Ellul |e verfasserin |4 aut | |
| 700 | 0 | |a Theodore Karapanayiotides |e verfasserin |4 aut | |
| 700 | 0 | |a Sotirios Giannopoulos |e verfasserin |4 aut | |
| 700 | 0 | |a Anne W. Alexandrov |e verfasserin |4 aut | |
| 700 | 0 | |a Andrei V. Alexandrov |e verfasserin |4 aut | |
| 700 | 0 | |a Georgios Tsivgoulis |e verfasserin |4 aut | |
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10.1177/1756285616659411 doi (DE-627)DOAJ073633798 (DE-599)DOAJ6ab252ea16d54439989822297fc32216 DE-627 ger DE-627 rakwb eng RC346-429 Aristeidis H. Katsanos verfasserin aut Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Neurology. Diseases of the nervous system Dimitris Mavridis verfasserin aut John Parissis verfasserin aut Spyridon Deftereos verfasserin aut Alexandra Frogoudaki verfasserin aut Agathi-Rosa Vrettou verfasserin aut Ignatios Ikonomidis verfasserin aut Maria Chondrogianni verfasserin aut Apostolos Safouris verfasserin aut Angeliki Filippatou verfasserin aut Konstantinos Voumvourakis verfasserin aut Nikos Triantafyllou verfasserin aut John Ellul verfasserin aut Theodore Karapanayiotides verfasserin aut Sotirios Giannopoulos verfasserin aut Anne W. Alexandrov verfasserin aut Andrei V. Alexandrov verfasserin aut Georgios Tsivgoulis verfasserin aut In Therapeutic Advances in Neurological Disorders SAGE Publishing, 2018 9(2016) (DE-627)573753849 (DE-600)2442245-9 17562864 nnns volume:9 year:2016 https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/article/6ab252ea16d54439989822297fc32216 kostenfrei https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/toc/1756-2856 Journal toc kostenfrei https://doaj.org/toc/1756-2864 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_121 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_636 GBV_ILN_2014 GBV_ILN_2704 GBV_ILN_2707 GBV_ILN_2889 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2016 |
| spelling |
10.1177/1756285616659411 doi (DE-627)DOAJ073633798 (DE-599)DOAJ6ab252ea16d54439989822297fc32216 DE-627 ger DE-627 rakwb eng RC346-429 Aristeidis H. Katsanos verfasserin aut Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Neurology. Diseases of the nervous system Dimitris Mavridis verfasserin aut John Parissis verfasserin aut Spyridon Deftereos verfasserin aut Alexandra Frogoudaki verfasserin aut Agathi-Rosa Vrettou verfasserin aut Ignatios Ikonomidis verfasserin aut Maria Chondrogianni verfasserin aut Apostolos Safouris verfasserin aut Angeliki Filippatou verfasserin aut Konstantinos Voumvourakis verfasserin aut Nikos Triantafyllou verfasserin aut John Ellul verfasserin aut Theodore Karapanayiotides verfasserin aut Sotirios Giannopoulos verfasserin aut Anne W. Alexandrov verfasserin aut Andrei V. Alexandrov verfasserin aut Georgios Tsivgoulis verfasserin aut In Therapeutic Advances in Neurological Disorders SAGE Publishing, 2018 9(2016) (DE-627)573753849 (DE-600)2442245-9 17562864 nnns volume:9 year:2016 https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/article/6ab252ea16d54439989822297fc32216 kostenfrei https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/toc/1756-2856 Journal toc kostenfrei https://doaj.org/toc/1756-2864 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_121 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_636 GBV_ILN_2014 GBV_ILN_2704 GBV_ILN_2707 GBV_ILN_2889 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2016 |
| allfields_unstemmed |
10.1177/1756285616659411 doi (DE-627)DOAJ073633798 (DE-599)DOAJ6ab252ea16d54439989822297fc32216 DE-627 ger DE-627 rakwb eng RC346-429 Aristeidis H. Katsanos verfasserin aut Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Neurology. Diseases of the nervous system Dimitris Mavridis verfasserin aut John Parissis verfasserin aut Spyridon Deftereos verfasserin aut Alexandra Frogoudaki verfasserin aut Agathi-Rosa Vrettou verfasserin aut Ignatios Ikonomidis verfasserin aut Maria Chondrogianni verfasserin aut Apostolos Safouris verfasserin aut Angeliki Filippatou verfasserin aut Konstantinos Voumvourakis verfasserin aut Nikos Triantafyllou verfasserin aut John Ellul verfasserin aut Theodore Karapanayiotides verfasserin aut Sotirios Giannopoulos verfasserin aut Anne W. Alexandrov verfasserin aut Andrei V. Alexandrov verfasserin aut Georgios Tsivgoulis verfasserin aut In Therapeutic Advances in Neurological Disorders SAGE Publishing, 2018 9(2016) (DE-627)573753849 (DE-600)2442245-9 17562864 nnns volume:9 year:2016 https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/article/6ab252ea16d54439989822297fc32216 kostenfrei https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/toc/1756-2856 Journal toc kostenfrei https://doaj.org/toc/1756-2864 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_121 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_636 GBV_ILN_2014 GBV_ILN_2704 GBV_ILN_2707 GBV_ILN_2889 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2016 |
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10.1177/1756285616659411 doi (DE-627)DOAJ073633798 (DE-599)DOAJ6ab252ea16d54439989822297fc32216 DE-627 ger DE-627 rakwb eng RC346-429 Aristeidis H. Katsanos verfasserin aut Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Neurology. Diseases of the nervous system Dimitris Mavridis verfasserin aut John Parissis verfasserin aut Spyridon Deftereos verfasserin aut Alexandra Frogoudaki verfasserin aut Agathi-Rosa Vrettou verfasserin aut Ignatios Ikonomidis verfasserin aut Maria Chondrogianni verfasserin aut Apostolos Safouris verfasserin aut Angeliki Filippatou verfasserin aut Konstantinos Voumvourakis verfasserin aut Nikos Triantafyllou verfasserin aut John Ellul verfasserin aut Theodore Karapanayiotides verfasserin aut Sotirios Giannopoulos verfasserin aut Anne W. Alexandrov verfasserin aut Andrei V. Alexandrov verfasserin aut Georgios Tsivgoulis verfasserin aut In Therapeutic Advances in Neurological Disorders SAGE Publishing, 2018 9(2016) (DE-627)573753849 (DE-600)2442245-9 17562864 nnns volume:9 year:2016 https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/article/6ab252ea16d54439989822297fc32216 kostenfrei https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/toc/1756-2856 Journal toc kostenfrei https://doaj.org/toc/1756-2864 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_121 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_636 GBV_ILN_2014 GBV_ILN_2704 GBV_ILN_2707 GBV_ILN_2889 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2016 |
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10.1177/1756285616659411 doi (DE-627)DOAJ073633798 (DE-599)DOAJ6ab252ea16d54439989822297fc32216 DE-627 ger DE-627 rakwb eng RC346-429 Aristeidis H. Katsanos verfasserin aut Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Neurology. Diseases of the nervous system Dimitris Mavridis verfasserin aut John Parissis verfasserin aut Spyridon Deftereos verfasserin aut Alexandra Frogoudaki verfasserin aut Agathi-Rosa Vrettou verfasserin aut Ignatios Ikonomidis verfasserin aut Maria Chondrogianni verfasserin aut Apostolos Safouris verfasserin aut Angeliki Filippatou verfasserin aut Konstantinos Voumvourakis verfasserin aut Nikos Triantafyllou verfasserin aut John Ellul verfasserin aut Theodore Karapanayiotides verfasserin aut Sotirios Giannopoulos verfasserin aut Anne W. Alexandrov verfasserin aut Andrei V. Alexandrov verfasserin aut Georgios Tsivgoulis verfasserin aut In Therapeutic Advances in Neurological Disorders SAGE Publishing, 2018 9(2016) (DE-627)573753849 (DE-600)2442245-9 17562864 nnns volume:9 year:2016 https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/article/6ab252ea16d54439989822297fc32216 kostenfrei https://doi.org/10.1177/1756285616659411 kostenfrei https://doaj.org/toc/1756-2856 Journal toc kostenfrei https://doaj.org/toc/1756-2864 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_121 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_374 GBV_ILN_602 GBV_ILN_636 GBV_ILN_2014 GBV_ILN_2704 GBV_ILN_2707 GBV_ILN_2889 GBV_ILN_2890 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2016 |
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Aristeidis H. Katsanos @@aut@@ Dimitris Mavridis @@aut@@ John Parissis @@aut@@ Spyridon Deftereos @@aut@@ Alexandra Frogoudaki @@aut@@ Agathi-Rosa Vrettou @@aut@@ Ignatios Ikonomidis @@aut@@ Maria Chondrogianni @@aut@@ Apostolos Safouris @@aut@@ Angeliki Filippatou @@aut@@ Konstantinos Voumvourakis @@aut@@ Nikos Triantafyllou @@aut@@ John Ellul @@aut@@ Theodore Karapanayiotides @@aut@@ Sotirios Giannopoulos @@aut@@ Anne W. Alexandrov @@aut@@ Andrei V. Alexandrov @@aut@@ Georgios Tsivgoulis @@aut@@ |
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RC346-429 Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis |
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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 W. Alexandrov Andrei V. Alexandrov Georgios Tsivgoulis |
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novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis |
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Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis |
| 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. |
| abstractGer |
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. |
| abstract_unstemmed |
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. |
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Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis |
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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 W. Alexandrov Andrei V. Alexandrov Georgios Tsivgoulis |
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