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《Chinese Journal of New Drugs and Clinical Remedies》 2017-11
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Efficacy and safety of dabigatran etexilate in comparison with rivaroxaban, apixaban and edoxaban for stroke prevention in non-valvular atrial fibrillation

YANG Hong-yi;FAN Qi;FAN Guo-rong;LI Qin;Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University;School of Pharmacy, Chongqing Medical University;  
AIM To compare the efficacy and safety of dabigatran etexilate with rivaroxaban, apixaban and edoxaban for stroke prevention in non-valvular atrial fibrillation( NVAF) according to relevant clinical studies. METHODS Four phase Ⅲ clinical trial reports about new oral anticoagulants(NOACs) compared with warfarin were selected. The incidence of efficacy and safety endpoints, such as stroke or systemic embolism and major bleeding, was extracted from each report. Then the efficacy and safety of the NOACs were compared by using Bucher method. RESULTS Compared to dabigatran etexilate( 110 mg, bid), rivaroxaban was not significantly different in stroke or systemic embolism(SE), but associated with more major bleeding(HR 1.30,95%CI 1.06-1.60). There was no significant differences with dabigatran etexilate(110 mg, bid) compared to apixaban and high-dose edoxaban for stroke or SE and major bleeding, but low-dose edoxaban was associated with lower major bleeding( HR 0.59, 95% CI 0.48-0.72). Compared to dabigatran etexilate( 150 mg, bid),rivaroxaban was associated with higher stroke or SE(HR 1.33, 95% CI 1.02-1.75), apixaban was associated with lower major bleeding(HR 0.74, 95%CI 0.61-0.91), and low-dose edoxaban was associated with higher stoke or SE(HR 1.71, 95%CI 1.30-2.25) and fewer major bleeding(HR 0.51, 95%CI 0.41-0.62). For highdose edoxaban, there were no significant differences in the stroke or SE and major bleeding. CONCLUSION In terms of efficacy, dabigatran etexilate(150 mg, bid) is optimal, and apixaban is equivalent to it. In terms of safety, low-dose edoxaban is optimal, followed by apixaban and dabigatran etexilate( 110 mg, bid), and rivaroxaban has the highest risk of bleeding.
【Fund】: 上海交通大学医学院2017年度医学教育研究项目(ZD170714)
【CateGory Index】: R541.75;R743.3
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