Apixaban rated most efficient at treating atrial fibrillation in a Meta Analysis 

In a meta-analysis comparing the drugs with each other and with warfarin, among direct-acting oral anticoagulants (DOACs) Apixaban was rated most efficient at treating atrial fibrillation. The study was published in The BMJ.

In a meta-analysis, The Researchers compared the efficacy, safety, and cost-effectiveness of direct-acting oral anticoagulants (DOACs) for patients with atrial fibrillation on evidence from separate studies. The study analyzed results from 23 randomized trials involving 94 656 patients with atrial fibrillation.

In the analyses, it was shown that several DOACs are of net benefit compared with warfarin.The risk of all-cause mortality was lower with all DOACs than with warfarin. The risk of intracranial bleeding was substantially lower for most DOACs compared with warfarin, whereas the risk of gastrointestinal bleeding was higher with some DOACs than warfarin. Apixaban 5 mg twice daily was ranked the highest for most outcomes and was cost-effective compared with warfarin.

As compared to warfarin, apixaban 5 mg twice daily, dabigatran 150 mg twice daily, edoxaban 60 mg once daily, and rivaroxaban 20 mg once daily reduced the risk of stroke or systemic embolism. The risk of stroke or systemic embolism was higher with edoxaban 60 mg once daily and rivaroxaban 20 mg once daily than with dabigatran 150 mg twice daily.The risk of major bleeding was higher with dabigatran 150 mg twice daily than apixaban 5 mg twice daily, rivaroxaban 20 mg twice daily than apixaban 5 mg twice daily, and rivaroxaban 20 mg twice daily than edoxaban 60 mg once daily.

It was found in the Meta-analyses that several DOACs are of net benefit compared with warfarin.The risk of all-cause mortality was lower with all DOACs than with warfarin. The risk of intracranial bleeding was substantially lower for most DOACs compared with warfarin, whereas the risk of gastrointestinal bleeding was higher with some DOACs than warfarin. Apixaban 5 mg twice daily was ranked the highest for most outcomes and was cost-effective compared with warfarin.

The authors concluded that as a class, DOACs reduced all-cause mortality relative to warfarin. Apixaban ranked highest "on the balance of efficacy, safety, and cost," among the other DOACs studied (betrixaban, edoxaban, rivaroxaban, and dabigatran),

The experts, however, are of the opinion that shared decision-making that takes patients' preferences and characteristics into account are preferable to "following a blanket recommendation that one anticoagulant is best."