Comparative Effectiveness and Safety of Direct Oral Anticoagulants: Overview of Systematic Reviews.
Emanuel RaschiMatteo BianchinMilo GattiAlessandro SquizzatoFabrizio De PontiPublished in: Drug safety (2020)
Direct oral anticoagulants are now recommended by major guidelines as first-choice agents for both stroke prevention in non-valvular atrial fibrillation and treatment/prevention of venous thromboembolism in non-cancer patients. Although there are no published head-to-head trials comparing different direct oral anticoagulants, a growing body of evidence from indirect comparisons and observational studies is suggesting that each direct oral anticoagulant may have a specific risk profile. This review aims to (1) synthesize and critically assess the latest evidence in comparative effectiveness and safety research in the aforementioned consolidated therapeutic uses, by performing an overview of systematic reviews and (2) highlight current challenges, namely underexplored areas, where research should be directed, also considering ongoing unpublished studies. The evidence gathered so far on the risk-benefit profile of direct oral anticoagulants is appraised in the light of existing guidelines to discuss whether further implementation should be proposed.
Keyphrases
- direct oral anticoagulants
- atrial fibrillation
- venous thromboembolism
- oral anticoagulants
- left atrial
- catheter ablation
- systematic review
- left atrial appendage
- meta analyses
- heart failure
- primary care
- clinical practice
- percutaneous coronary intervention
- healthcare
- quality improvement
- randomized controlled trial
- aortic valve
- coronary artery disease
- mitral valve
- acute coronary syndrome
- case control