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

News | Antiplatelet and Anticoagulation Therapies

November 17, 2021 — Taking daily low-dose aspirin for seven years did not affect the risk of dementia or mental decline ...

Home November 17, 2021
Home
News | Antiplatelet and Anticoagulation Therapies

November 9, 2021 — Utilizing a magnetically-controlled capsule endoscopy system, the double-blind, randomized OPT-PEACE ...

Home November 09, 2021
Home
News | Antiplatelet and Anticoagulation Therapies
October 4, 2021 — One month of dual antiplatelet therapy (DAPT) following stent implantation in high bleeding risk ...
Home October 04, 2021
Home
News | Antiplatelet and Anticoagulation Therapies

September 1, 2021 — The STOPDAPT-2 ACS trial does not support the use of one month of dual antiplatelet therapy (DAPT) ...

Home September 01, 2021
Home
News | Antiplatelet and Anticoagulation Therapies

September 1, 2021 – The anticoagulant edoxaban (Savaysa) may be just as effective as warfarin for preventing heart ...

Home September 01, 2021
Home
News | Antiplatelet and Anticoagulation Therapies

June 21, 2021 — The U.S. Food and Drug Administration (FDA) approved Boehringer Ingelheim's dabigatran etexilate ...

Home June 21, 2021
Home
News | Antiplatelet and Anticoagulation Therapies

May 15, 2021 — The ADAPTABLE trial found no significant differences in cardiovascular events or major bleeding in ...

Home May 15, 2021
Home
News | Antiplatelet and Anticoagulation Therapies

April 28, 2021 — An analysis of the prospective Chinese Fuwai PCI Registry, confirms long-term, dual-antiplatelet ...

Home April 28, 2021
Home
Feature | Antiplatelet and Anticoagulation Therapies | By Dave Fornell, Editor

A comprehensive review or more than 80 randomized controlled trials (RCTs) investigating how to best manage optimal ...

Home March 22, 2021
Home
Videos | Antiplatelet and Anticoagulation Therapies

The COMPARE CRUSH Trial looked at the effect of per-hospital crushed prasugrel tablets in patients with STEMI planned ...

Home October 19, 2020
Home
Subscribe Now