Comparison of non-vitamin K antagonist oral anticoagulants on bleeding and thrombosis

source extracted confidence: high 2026-04-09
#anticoagulants #dabigatran #factor-xa-inhibitors #hemorrhage #humans

Comparison of non-vitamin K antagonist oral anticoagulants on bleeding and thrombosis

Liu et al., 2021 | J Clin Pharm Ther | Meta Analysis

Citation

Liu Zhiyan, Ma Lingyue, ... Cui Yimin. Comparison of non-vitamin K antagonist oral anticoagulants on bleeding and thrombosis. J Clin Pharm Ther. 2021-Dec;46(6):1729-1742. doi:10.1111/jcpt.13514

Abstract

WHAT IS KNOWN AND OBJECTIVE: Limited data are available for the comparison between different non-vitamin K antagonist oral anticoagulants (NOACs) on clinical outcomes. We aimed to provide evidence of different NOACs for patients with non-valvular atrial fibrillation (NVAF). METHODS: Electronic databases were searched from inception through 22 March 2020 to identify eligible studies in which clinical outcomes (stroke, systemic embolism [SE], bleeding or death events) were directly compared between different NOACs. RESULTS: 29 real-world studies enrolled more than 700,000 patients were included. Compared with dabigatran, apixaban had higher risk of death (OR 1.07), major bleeding (1.43), GI bleeding (1.64), ischaemic stroke and stroke/SE events (1.10); rivaroxaban had higher risk of death (1.28), major bleeding (1.24), GI bleeding (1.14) and ischaemic stroke (1.08). Compared with rivaroxaban, apixaban had lower risk of death (0.8), major bleeding (0.56) and ischaemic stroke events (0.71). Compared with edoxaban, rivaroxaban had higher risk of major bleeding (2.83), GI bleeding (5.18) and ischaemic stroke (2.28). WHAT IS NEW AND CONCLUSION: In view of the global burden of disease and the routine use of NOACs worldwide, the findings have immediate and important implications. Our data suggested that apixaban might be the priority choice in prevention of bleeding and stroke and dabigatran could be the priority choice in prevention of death events. TRIAL REGISTRATION: This systematic review and meta-analysis were conducted and reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA), Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and was registered with PROSPERO (CRD42019140553).

Key Findings

29 real-world studies enrolled more than 700,000 patients were included. Compared with dabigatran, apixaban had higher risk of death (OR 1.07), major bleeding (1.43), GI bleeding (1.64), ischaemic stroke and stroke/SE events (1.10); rivaroxaban had higher risk of death (1.28), major bleeding (1.24), GI bleeding (1.14) and ischaemic stroke (1.08). Compared with rivaroxaban, apixaban had lower risk of death (0.8), major bleeding (0.56) and ischaemic stroke events (0.71). Compared with edoxaban, ri

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population non
Sample Size 700000
Age Range See abstract
Condition See abstract

MeSH Terms

  • Anticoagulants
  • Dabigatran
  • Factor Xa Inhibitors
  • Hemorrhage
  • Humans
  • Ischemic Stroke
  • Pyrazoles
  • Pyridones
  • Rivaroxaban
  • Thrombosis

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09