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AF thromboembolic prophylaxis should focus on drug efficacy, not pharmacologic class
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In patients with atrial fibrillation, researchers found no significant class effect for direct thrombin inhibitors or factor Xa inhibitors, according to meta-analysis results. In addition, they saw no pronounced benefit for a particular dosing regimen.
“All differences and trends in the comparisons could be explained by results of isolated trials that were not reproduced by other agents of the same class or with the same dosing regimen,” Rui Providência, MD, of the Universitario de Coimbra, and colleagues wrote in their study. “Thus, current evidence shows that the choice of a [novel oral anticoagulants] for [atrial fibrillation] thromboembolic prophylaxis should be adapted to the individual patient and focused on the drug itself, rather than its pharmacologic class.”
For this study, Providência and colleagues searched the MEDLINE, Embase and Cochrane databases for phase 3 randomized controlled trials of direct thrombin inhibitors and factor Xa inhibitors compared with warfarin in patients with atrial fibrillation (AF). Seven studies, involving 80,290 patients, met their selection criteria.
The pooled results showed that both direct thrombin inhibitors and factor Xa inhibitors were superior to warfarin for most efficacy and safety endpoints: including incidence of stroke or systemic embolism, intracranial bleeding, and total and cardiovascular mortality.
However, these results offered no support for a possible class effect of either medication, the authors wrote. Among the trials that suggested a beneficial effect of a particular drug class, the authors noted considerable heterogeneity, which they attributed to an effect of individual studies or drugs, rather than a specific class effect.
Furthermore, the researchers did not observe any significant differences in favor of either a once-daily or twice-daily novel anticoagulation dosing regimen.
Disclosures: Providência reports receiving honoraria as a speaker/consultant for Boehringer Ingelheim and as a co-investigator in the ENGAGE-AF TIMI 48 trial. Please see the full study for a list of all other authors’ relevant financial disclosures.
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