CLC number: R541.7+5
On-line Access: 2017-07-05
Received: 2016-03-31
Revision Accepted: 2016-10-23
Crosschecked: 2017-06-16
Cited: 1
Clicked: 7678
Citations: Bibtex RefMan EndNote GB/T7714
Wei-wei Xu, Shen-jiang Hu, Tao Wu. Risk analysis of new oral anticoagulants for gastrointestinal bleeding and intracranial hemorrhage in atrial fibrillation patients: a systematic review and network meta-analysis[J]. Journal of Zhejiang University Science B, 2017, 18(7): 567-576.
@article{title="Risk analysis of new oral anticoagulants for gastrointestinal bleeding and intracranial hemorrhage in atrial fibrillation patients: a systematic review and network meta-analysis",
author="Wei-wei Xu, Shen-jiang Hu, Tao Wu",
journal="Journal of Zhejiang University Science B",
volume="18",
number="7",
pages="567-576",
year="2017",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1600143"
}
%0 Journal Article
%T Risk analysis of new oral anticoagulants for gastrointestinal bleeding and intracranial hemorrhage in atrial fibrillation patients: a systematic review and network meta-analysis
%A Wei-wei Xu
%A Shen-jiang Hu
%A Tao Wu
%J Journal of Zhejiang University SCIENCE B
%V 18
%N 7
%P 567-576
%@ 1673-1581
%D 2017
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1600143
TY - JOUR
T1 - Risk analysis of new oral anticoagulants for gastrointestinal bleeding and intracranial hemorrhage in atrial fibrillation patients: a systematic review and network meta-analysis
A1 - Wei-wei Xu
A1 - Shen-jiang Hu
A1 - Tao Wu
J0 - Journal of Zhejiang University Science B
VL - 18
IS - 7
SP - 567
EP - 576
%@ 1673-1581
Y1 - 2017
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1600143
Abstract: Background: Antithrombotic therapy using new oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding (GIB) and intracranial hemorrhage (ICH), we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs. Methods: We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents (and doses) were treated as separate nodes. Odds ratios (ORs) and 95% confidence intervals (CIs) were modeled using Markov chain Monte Carlo methods. Results: Indirect comparisons with the Bayesian model confirmed that aspirin+clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo (OR 0.33, 95% CI 0.01–0.92). Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg (OR 3.42, 95% CI 1.22–7.24) and dabigatran 110 mg (OR 3.56, 95% CI 1.10–8.45). We further ranked the NOACs for the lowest risk of GIB (apixaban 5 mg) and ICH (apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg). Conclusions: Bayesian network meta-analysis of treatment of non-valvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.
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