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Direct Oral Anticoa...
Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation : Patient-Level Network Meta-Analyses of Randomized Clinical Trials With Interaction Testing by Age and Sex
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- Carnicelli, Anthony P. (författare)
- Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Hong, Hwanhee (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.;Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA.
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- Connolly, Stuart J. (författare)
- McMaster Univ, Dept Med, Hamilton, ON, Canada.;Populat Hlth Res Inst, Hamilton, ON, Canada.
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- Eikelboom, John (författare)
- McMaster Univ, Dept Med, Hamilton, ON, Canada.;Populat Hlth Res Inst, Hamilton, ON, Canada.
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- Giugliano, Robert P. (författare)
- Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.;Thrombolysis Myocardial Infarct Study Grp, Boston, MA USA.
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- Morrow, David A. (författare)
- Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.;Thrombolysis Myocardial Infarct Study Grp, Boston, MA USA.
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- Patel, Manesh R. (författare)
- Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Wallentin, Lars, 1943- (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Alexander, John H. (författare)
- Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Cecilia Bahit, M. (författare)
- INECO Neurociencias Orono, Dept Cardiol, Santa Fe, Argentina.
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- Benz, Alexander P. (författare)
- Populat Hlth Res Inst, Hamilton, ON, Canada.
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- Bohula, Erin A. (författare)
- Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.;Thrombolysis Myocardial Infarct Study Grp, Boston, MA USA.
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- Chao, Tze-Fan (författare)
- Taipei Vet Gen Hosp, Div Cardiol, Taipei, Taiwan.
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- Dyal, Leanne (författare)
- Populat Hlth Res Inst, Hamilton, ON, Canada.
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- Ezekowitz, Michael (författare)
- Lankenau Inst Med Res, Wynnewood, PA USA.
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- A.a. Fox, Keith (författare)
- Univ Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland.
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- Gencer, Baris (författare)
- Geneva Univ Hosp, Div Cardiol, Geneva, Switzerland.;Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland.
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- Halperin, Jonathan L. (författare)
- Mt Sinai Med Ctr, Cardiovasc Inst, New York, NY 10029 USA.
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- Hijazi, Ziad (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Hohnloser, Stefan H. (författare)
- Goethe Univ Frankfurt, Dept Cardiol, Frankfurt, Germany.
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- Hua, Kaiyuan (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.;Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA.
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- Hylek, Elaine (författare)
- Boston Univ, Dept Med, Sch Med, Boston, MA 02215 USA.
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- Toda Kato, Eri (författare)
- Kyoto Univ, Dept Cardiol, Kyoto, Japan.
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- Kuder, Julia (författare)
- Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.
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- Lopes, Renato D. (författare)
- Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Mahaffey, Kenneth W. (författare)
- Stanford Univ, Sch Med, Dept Med, Stanford Ctr Clin Res, Stanford, CA 94305 USA.
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- Oldgren, Jonas, 1964- (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Piccini, Jonathan P. (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Ruff, Christian T. (författare)
- Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.;Thrombolysis Myocardial Infarct Study Grp, Boston, MA USA.
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- Steffel, Jan (författare)
- Univ Zurich, Dept Cardiol, Zurich, Switzerland.
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- Wojdyla, Daniel (författare)
- Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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- Granger, Christopher B. (författare)
- Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.
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Duke Univ, Div Cardiol, Durham, NC USA;Duke Univ, Duke Clin Res Inst, Durham, NC USA. Duke Univ, Duke Clin Res Inst, Durham, NC USA.;Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA. (creator_code:org_t)
- Ovid Technologies (Wolters Kluwer Health), 2022
- 2022
- Engelska.
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 145:4, s. 242-255
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Background: Direct oral anticoagulants (DOACs) are preferred over warfarin for stroke prevention in atrial fibrillation. Meta-analyses using individual patient data offer substantial advantages over study-level data.Methods: We used individual patient data from the COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation) database, which includes all patients randomized in the 4 pivotal trials of DOACs versus warfarin in atrial fibrillation (RE-LY [Randomized Evaluation of Long-Term Anticoagulation Therapy], ROCKET AF [Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation], ARISTOTLE [Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation], and ENGAGE AF-TIMI 48 [Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48]), to perform network meta-analyses using a stratified Cox model with random effects comparing standard-dose DOAC, lower-dose DOAC, and warfarin. Hazard ratios (HRs [95% CIs]) were calculated for efficacy and safety outcomes. Covariate-by-treatment interaction was estimated for categorical covariates and for age as a continuous covariate, stratified by sex.Results: A total of 71 683 patients were included (29 362 on standard-dose DOAC, 13 049 on lower-dose DOAC, and 29 272 on warfarin). Compared with warfarin, standard-dose DOACs were associated with a significantly lower hazard of stroke or systemic embolism (883/29 312 [3.01%] versus 1080/29 229 [3.69%]; HR, 0.81 [95% CI, 0.74-0.89]), death (2276/29 312 [7.76%] versus 2460/29 229 [8.42%]; HR, 0.92 [95% CI, 0.87-0.97]), and intracranial bleeding (184/29 270 [0.63%] versus 409/29 187 [1.40%]; HR, 0.45 [95% CI, 0.37-0.56]), but no statistically different hazard of major bleeding (1479/29 270 [5.05%] versus 1733/29 187 [5.94%]; HR, 0.86 [95% CI, 0.74-1.01]), whereas lower-dose DOACs were associated with no statistically different hazard of stroke or systemic embolism (531/13 049 [3.96%] versus 1080/29 229 [3.69%]; HR, 1.06 [95% CI, 0.95-1.19]) but a lower hazard of intracranial bleeding (55/12 985 [0.42%] versus 409/29 187 [1.40%]; HR, 0.28 [95% CI, 0.21-0.37]), death (1082/13 049 [8.29%] versus 2460/29 229 [8.42%]; HR, 0.90 [95% CI, 0.83-0.97]), and major bleeding (564/12 985 [4.34%] versus 1733/29 187 [5.94%]; HR, 0.63 [95% CI, 0.45-0.88]). Treatment effects for standard- and lower-dose DOACs versus warfarin were consistent across age and sex for stroke or systemic embolism and death, whereas standard-dose DOACs were favored in patients with no history of vitamin K antagonist use (P=0.01) and lower creatinine clearance (P=0.09). For major bleeding, standard-dose DOACs were favored in patients with lower body weight (P=0.02). In the continuous covariate analysis, younger patients derived greater benefits from standard-dose (interaction P=0.02) and lower-dose DOACs (interaction P=0.01) versus warfarin.Conclusions: Compared with warfarin, DOACs have more favorable efficacy and safety profiles among patients with atrial fibrillation.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- anticoagulants
- atrial fibrillation
- meta-analysis
- stroke
- warfarin
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Carnicelli, Anth ...
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Hong, Hwanhee
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Connolly, Stuart ...
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Eikelboom, John
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Giugliano, Rober ...
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Morrow, David A.
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visa fler...
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Patel, Manesh R.
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Wallentin, Lars, ...
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Alexander, John ...
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Cecilia Bahit, M ...
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Benz, Alexander ...
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Bohula, Erin A.
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Chao, Tze-Fan
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Dyal, Leanne
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Ezekowitz, Micha ...
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A.a. Fox, Keith
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Gencer, Baris
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Halperin, Jonath ...
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Hijazi, Ziad
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Hohnloser, Stefa ...
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Hua, Kaiyuan
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Hylek, Elaine
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Toda Kato, Eri
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Kuder, Julia
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Lopes, Renato D.
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Mahaffey, Kennet ...
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Oldgren, Jonas, ...
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Piccini, Jonatha ...
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Ruff, Christian ...
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Steffel, Jan
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Wojdyla, Daniel
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Granger, Christo ...
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