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Direct Anticoagulants and Risk of Myocardial Infarction, a Multiple Treatment Network Meta-Analysis

Péter Kupó1, Zsolt Szakács2,3, Margit Solymár2

  • 1Heart Institute, Medical School, University of Pécs, Pécs, Hungary.

Angiology
|September 20, 2019
PubMed

Insights

Long-term direct-acting oral anticoagulant (DOAC) treatment shows varied cardiovascular safety. Rivaroxaban demonstrated a reduced risk of myocardial infarction (MI) compared to placebo and dabigatran.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Direct-acting oral anticoagulants (DOACs) are widely used for thromboprophylaxis.
  • Assessing the long-term cardiovascular safety of DOACs is crucial for clinical decision-making.
  • Heterogeneity in cardiovascular safety profiles among different oral anticoagulants necessitates comparative analysis.

Purpose of the Study:

  • To evaluate the cardiovascular safety of long-term direct-acting oral anticoagulant (DOAC) treatment.
  • To compare the incidence of myocardial infarction (MI) among various DOACs, vitamin K antagonists (VKAs), and placebo.

Main Methods:

  • Systematic literature search of randomized clinical trials (RCTs) up to May 31, 2019.
  • Inclusion of 28 RCTs involving 196,761 patients assessing DOAC efficacy and/or safety.
  • Application of fixed-effect and random-effects models to analyze outcomes including MI, major bleeding, and mortality.

Main Results:

  • Rivaroxaban showed a 21% relative risk reduction in MI versus placebo (RR: 0.79) and 31% versus dabigatran (RR: 0.70).
  • Apixaban demonstrated a 24% risk reduction in MI compared to dabigatran (RR: 0.76).
  • Vitamin K antagonists offered a 19% risk reduction in MI compared to dabigatran (RR: 0.81).

Conclusions:

  • Cardiovascular safety profiles exhibit significant heterogeneity across different oral anticoagulants.
  • Rivaroxaban is associated with a reduced rate of myocardial infarction, suggesting it as a potentially favorable option.
  • Further comparative studies are warranted to fully elucidate the long-term cardiovascular safety of DOACs.
Keywords:
myocardial infarctionnetwork meta-analysisnon-vitamin k antagonist oral anticoagulants

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