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Comparative Effectiveness and Safety of Direct Oral Anticoagulants: Overview of Systematic Reviews

Author

Listed:
  • Emanuel Raschi

    (University of Bologna)

  • Matteo Bianchin

    (University of Bologna)

  • Milo Gatti

    (University of Bologna)

  • Alessandro Squizzato

    (University of Insubria)

  • Fabrizio De Ponti

    (University of Bologna)

Abstract

Direct oral anticoagulants are now recommended by major guidelines as first-choice agents for both stroke prevention in non-valvular atrial fibrillation and treatment/prevention of venous thromboembolism in non-cancer patients. Although there are no published head-to-head trials comparing different direct oral anticoagulants, a growing body of evidence from indirect comparisons and observational studies is suggesting that each direct oral anticoagulant may have a specific risk profile. This review aims to (1) synthesize and critically assess the latest evidence in comparative effectiveness and safety research in the aforementioned consolidated therapeutic uses, by performing an overview of systematic reviews and (2) highlight current challenges, namely underexplored areas, where research should be directed, also considering ongoing unpublished studies. The evidence gathered so far on the risk–benefit profile of direct oral anticoagulants is appraised in the light of existing guidelines to discuss whether further implementation should be proposed.

Suggested Citation

  • Emanuel Raschi & Matteo Bianchin & Milo Gatti & Alessandro Squizzato & Fabrizio De Ponti, 2019. "Comparative Effectiveness and Safety of Direct Oral Anticoagulants: Overview of Systematic Reviews," Drug Safety, Springer, vol. 42(12), pages 1409-1422, December.
    • Handle: RePEc:spr:drugsa:v:42:y:2019:i:12:d:10.1007_s40264-019-00866-7
    DOI: 10.1007/s40264-019-00866-7
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    References listed on IDEAS

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    1. Patricia McGettigan & Carla Alonso Olmo & Kelly Plueschke & Mireia Castillon & Daniel Nogueras Zondag & Priya Bahri & Xavier Kurz & Peter G. M. Mol, 2019. "Patient Registries: An Underused Resource for Medicines Evaluation," Drug Safety, Springer, vol. 42(11), pages 1343-1351, November.
    2. Emanuel Raschi & Matteo Bianchin & Walter Ageno & Roberto De Ponti & Fabrizio De Ponti, 2016. "Risk–Benefit Profile of Direct-Acting Oral Anticoagulants in Established Therapeutic Indications: An Overview of Systematic Reviews and Observational Studies," Drug Safety, Springer, vol. 39(12), pages 1175-1187, December.
    3. Guillermo Prada-Ramallal & Bahi Takkouche & Adolfo Figueiras, 2017. "Summarising the Evidence for Drug Safety: A Methodological Discussion of Different Meta-Analysis Approaches," Drug Safety, Springer, vol. 40(7), pages 547-558, July.
    4. John Leonard Fitzgerald & Laurence Guy Howes, 2016. "Drug Interactions of Direct-Acting Oral Anticoagulants," Drug Safety, Springer, vol. 39(9), pages 841-845, September.
    5. Géric Maura & Cécile Billionnet & Joël Coste & Alain Weill & Anke Neumann & Antoine Pariente, 2018. "Non-bleeding Adverse Events with the Use of Direct Oral Anticoagulants: A Sequence Symmetry Analysis," Drug Safety, Springer, vol. 41(9), pages 881-897, September.
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