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Comparison of Watchman device with new oral anti-coagulants in patients with atrial fibrillation: A network meta-analysis.

by Koifman, Edward; Lipinski, Michael J; Escarcega, Ricardo O; Didier, Romain; Kiramijyan, Starkis; Torguson, Rebecca; Waksman, Ron.
Citation: International Journal of Cardiology. 205:17-22, 2016 Feb 15..Journal: International journal of cardiology.Published: 2016ISSN: 0167-5273.Full author list: Koifman E; Lipinski MJ; Escarcega RO; Didier R; Kiramijyan S; Torguson R; Waksman R.UI/PMID: 26709135.Subject(s): Administration, Oral | *Anticoagulants/ad [Administration & Dosage] | Anticoagulants/ae [Adverse Effects] | Atrial Fibrillation/di [Diagnosis] | Atrial Fibrillation/ep [Epidemiology] | *Atrial Fibrillation/th [Therapy] | Clinical Trials as Topic/mt [Methods] | Dabigatran/ad [Administration & Dosage] | Dabigatran/ae [Adverse Effects] | Defibrillators, Implantable/ae [Adverse Effects] | *Defibrillators, Implantable/st [Standards] | Hemorrhage/ci [Chemically Induced] | Humans | Pyrazoles/ad [Administration & Dosage] | Pyrazoles/ae [Adverse Effects] | Pyridines/ad [Administration & Dosage] | Pyridines/ae [Adverse Effects] | Pyridones/ad [Administration & Dosage] | Pyridones/ae [Adverse Effects] | Thiazoles/ad [Administration & Dosage] | Thiazoles/ae [Adverse Effects] | Warfarin/ad [Administration & Dosage] | Warfarin/ae [Adverse Effects]Institution(s): MedStar Washington Hospital Center | MedStar Washington Hospital Center | MedStar Washington Hospital Center | MedStar Washington Hospital Center | MedStar Washington Hospital Center | MedStar Washington Hospital Center | MedStar Washington Hospital CenterDepartment(s): MedStar Heart Institute | MedStar Heart Institute | MedStar Heart Institute | MedStar Heart Institute | MedStar Heart Institute | MedStar Heart Institute | MedStar Heart InstituteActivity type: Journal Article.Medline article type(s): Comparative Study | Journal Article | Meta-AnalysisAbbreviated citation: Int J Cardiol. 205:17-22, 2016 Feb 15.Abstract: BACKGROUND: New oral anticoagulants (NOAC) and the Watchman device represent an alternative to warfarin for stroke prophylaxis in atrial fibrillation (AF) patients. However, no studies compare these new treatments. We performed a network meta-analysis to indirectly compare Watchman and NOACs among AF patients.Abstract: METHODS: We performed a MEDLINE search for studies comparing warfarin with NOACs (dabigatran, rivaroxaban, apixaban and edoxaban) or Watchman in AF patients with reported clinical outcomes. Mixed treatment comparison model generation was performed to directly and indirectly compare NOACs, warfarin and Watchman.Abstract: RESULTS: 14 studies with 246,005 patients were included in the analysis, among which 124,823 were treated with warfarin, 120,450 were treated with NOACs and 732 had Watchman implanted. Mean age was 72 +/- 9 years, 53% were male, and mean CHADS2 score was 2.1 +/- 1.6. Both NOACs and Watchman were superior to warfarin in hemorrhagic stroke prevention (OR = 0.46 [0.30-0.82] and OR = 0.21 [0.05-0.99], respectively). NOACs significantly reduced total stroke (OR = 0.78 [0.58-0.96]) and major bleeding (OR = 0.78 [0.65-0.91]) compared with warfarin. Indirect comparison between NOAC and Watchman revealed no significant differences in outcomes, though there was a trend toward higher rates of ischemic stroke with Watchman compared with NOAC (OR 2.60 [0.60-13.96]) with the opposite findings with hemorrhagic stroke (OR = 0.44 [0.09-2.14]).Abstract: CONCLUSIONS: NOAC therapy was superior to warfarin for multiple outcomes while Watchman reduced hemorrhagic stroke. Further studies are needed to assess Watchman versus NOAC to optimize therapy for stroke prevention in AF patients.Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved.

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