News | Atrial Fibrillation | October 25, 2016

New Study Compares Stroke Prevention Treatments for Non-valvular Atrial Fibrillation Patients

Results suggest no one treatment is universally appropriate, and treatment must be personalized to patients

UAB, University of Alabama at Birmingham study, stroke prevention, non-valvular atrial fibrillation, NVAF

October 25, 2016 — A recent study from University of Alabama at Birmingham (UAB) researchers published in PLOS ONE compares different available treatments for stroke prevention in patients with non-valvular atrial fibrillation (NVAF).

The group identified six clinical trials with 59,627 patients comparing six different U.S. Food and Drug Administration (FDA)-approved treatment alternatives. The study combined all phase-three randomized controlled clinical trials comparing different novel oral blood thinners, left atrial appendage closure (Watchman) devices and Coumadin (warfarin) for stroke prevention in patients with NVAF. Investigators reported data on ischemic stroke, major bleeding and primary safety endpoint from these clinical trials.

Watchman left atrial appendage devices are used as an alternative to long-term warfarin therapy for stroke risk-reduction patients with non-valvular atrial fibrillation.

UAB doctors say too many options may not be a good thing.

“The occurrence of multiple treatment pathways has presented dilemmas for the clinicians,” said Navkaranbir S. Bajaj, M.D., the first author of the PLOS ONE study who designed and conducted the analyses for the study.

“We exploited the fact that no direct comparisons from trials were available between Watchman and novel oral anticoagulants,” said Bajaj, instructor fellow in the division of cardiovascular disease.

The study explains that, while direct evidence from randomized controlled trials is lacking, indirect comparisons using systematic network meta-analyses can provide useful complementary information that may be less biased than the direct evidence.

Researchers have found that all treatments had comparable efficacy in reducing stroke rates. However, Apixaban, one of the novel oral blood thinners, was a clear winner in terms of safety profile, and the Watchman device was ranked last due to a higher number of procedural adverse events.

“In an era of precision medicine, we need to individualize treatment for our patients,” said senior author Pankaj Arora, M.D., assistant professor in the Division of Cardiovascular Disease. “Our current analysis gives insight into how one can do that to prevent stroke in patients with atrial fibrillation.”

Arora said one size does not fit all, and his clinical translational research group is actively working to apply this order to all cardiovascular diseases. The authors concluded that the trade-off between safety and efficacy should be the driving force, and the hierarchical ranking presented in this paper can serve as a clinical tool to guide selection of therapy in patients with atrial fibrillation.

For more information: www.plosone.org

Related Content

Sponsored Content | Videos | EP Lab| May 26, 2017
DAIC Editor Dave Fornell takes a tour of some of the most innovative new electrophysiology (EP) technology at the 201
Statins Associated With Improved Heart Structure and Function
News | Pharmaceuticals| May 26, 2017
Statins are associated with improved heart structure and function, according to research presented at EuroCMR 2017, May...
Arto System Shows Promise as Less-Invasive Therapy for Heart Failure Patients
News | Heart Failure| May 26, 2017
Recent outcomes from the MAVERIC clinical trial confirm earlier positive findings that MVRx’s Arto System safely and...
Sponsored Content | Videos | Leads Implantable Devices| May 25, 2017
Bruce Wilkoff, M.D., director of cardiac pacing and tachyarrhythmia devices at Cleveland Clinic, discusses advancemen
Intensive Glycemic Control Program Produces Significant Per-Patient Cost Savings for CABG Surgery
News | Cardiovascular Surgery| May 25, 2017
A new study from Emory University observed a near-20 percent reduction in perioperative complications, a 1.2-day...
Edwards Lifesciences Centera self expanding transcatheter (TAVR) valve
News | Heart Valve Technology| May 24, 2017
May 24, 2017 — Late-breaking data presented at EuroPCR 2017 demonstrating excellent clinical outcomes for...
Biotronik Home Monitoring implanted EP device remote wireless monitoring system
News | May 24, 2017
May 23, 2017 – Results now published in the European Heart Journal show Biotronik Home Monitoring reduces th
3-D Echo Image Analysis With Philips' HeartModel A.I. is Accurate and Reproducible
News | Cardiovascular Ultrasound| May 24, 2017
May 24, 2017 — Philips recently announced the results from a global study indicating that automated...
Heart Failure Mortality Inversely Related to Wealth of Country
News | Heart Failure| May 24, 2017
Death in patients with heart failure is inversely related to the wealth of the country they live in, according to late...
Shockwave Medical Announces CE Mark for Coronary Lithoplasty System and Activities at EuroPCR 2017
News | Cath Lab| May 23, 2017
Shockwave Medical announced last week CE Mark for the company’s Coronary Lithoplasty System for the treatment of...
Overlay Init