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Antithrombotic Agents for the Prevention of Stroke and Systemic Embolism in Patients With Atrial Fibrillation [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2013 Mar. (CADTH Therapeutic Review, No. 1.1B.)

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Antithrombotic Agents for the Prevention of Stroke and Systemic Embolism in Patients With Atrial Fibrillation [Internet].

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6CONCLUSIONS AND IMPLICATIONS FOR DECISION-OR POLICY-MAKING

The results of the current review revealed that there were statistically significant differences in clinical outcomes in AF patients between the NOACs and warfarin, although it is unclear whether the ARD associated with these differences translate into clinically meaningful benefits in practice. In addition, NOACs may be cost-effective alternatives to warfarin for preventing SSE in AF patients. More specifically, if it is assumed that the λ is $50,000, then among the NOACs, dabigatran 150 mg twice daily is likely the optimal therapy in patients who have a moderate risk of stroke (CHADS2 = 1), or are relatively young (≤ 70 years old), or who cannot maintain an adequate INR control (TTR < 66%); apixaban 5 mg twice daily would likely be the optimal NOAC therapy in patients who have a high risk of stroke (CHADS2 score ≥ 2), or are relatively old (≥ 80 years old).

The current review extends our previous report by demonstrating that anticoagulant therapy is superior to ASA, both in terms of clinical benefit and cost-effectiveness, irrespective of whether ASA is co-administered with clopidogrel. Anticoagulant therapy would appear to be a superior treatment option for preventing SSE in patients with non-valvular AF in patients with a moderate or high risk of stroke (CHADS2 score ≥ 1). The superiority of the anticoagulant drugs versus the antiplatelet drugs was consistent irrespective of age and the degree of INR control (TTR). There was, however, insufficient evidence to compare anticoagulant drugss to antiplatelet drugs in patients with a low risk of stroke (CHADS2 score = 0).

These results must be considered in the light of several limitations that create uncertainty, most notably the reliance on indirect comparison methodology to compare the different treatments.

Copyright © CADTH February 2013.

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Bookshelf ID: NBK168977

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