Coronary Artery DiseaseMeta-Analysis of the Safety and Efficacy of the Oral Anticoagulant Agents (Apixaban, Rivaroxaban, Dabigatran) in Patients With Acute Coronary Syndrome
Section snippets
Methods
The present meta-analysis is conducted according to Cochrane Collaboration guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses report.11, 12 The following inclusion criteria were set: (1) randomized clinical trials (phase II and III) investigating commonly prescribed NOACs (apixaban, rivaroxaban, and dabigatran) in patients with ACS, (2) included studies had to report outcomes of interest (see below) in adult population (aged ≥18 years), and
Results
In the selected trials, APPRAISE, APPRAISE-2, ATLAS ACS-TIMI 46 (Anti-Xa Therapy to Lower cardiovascular events in addition to Aspirin with or without thienopyridine therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction trial 46), ATLAS ACS-TIMI 51, and REDEEM (Dabigatran vs placebo in patients with ACS on DAPT: a randomized, double-blind, phase II trial) investigated the effects of NOACs in patients with recent ACS, whereas both PIONEER AF and RE DUAL PCI
Discussion
The cardiologists should continue to engage in efforts to encounter the risk of recurrent ischemia in patients with ACS. The professional guidelines are clear about the parenteral anticoagulants during the acute care of ACS; however, their role is not clearly defined after hospital discharge. In the recent times, there is an ongoing effort to assess the effects of NOACs in this regard. We have combined all the phase II and III clinical trials of commonly used NOACs, which have investigated
Disclosures
Dr. Kaluski is a speaker and consultant for Bristol-Myers Squibb, Pfizer, Janssen, and Daiichi-Saknyo. The authors have not received any funding for this project.
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Cited by (21)
Minding the gap – Heterogeneity of antithrombotic treatment preferences in complex scenarios in absence of evidence-based guidelines
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2019, ChestCitation Excerpt :When added to single platelet therapy following ACS, DOACs were well tolerated but did not lead to a reduction in major adverse cardiovascular events. When added to dual platelet therapy following ACS, DOACs resulted in a reduction in major adverse cardiovascular events but were associated with an increased risk of major bleeding.32 In patients with acute ischemic stroke, American Heart Association/American Stroke Association 2018 expert guidelines caution against the use of IV thrombolytic therapy in patients who are receiving DOAC therapies at the time of presentation.33
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2018, Journal of Thrombosis and HaemostasisNon-vitamin-K-antagonist oral anticoagulants (NOACs) after acute myocardial infarction: a network meta-analysis
2024, Cochrane Database of Systematic ReviewsTrends in Off-Label Indications of Non-Vitamin K Antagonist Oral Anticoagulants in Acute Coronary Syndrome
2023, Reviews in Cardiovascular Medicine
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