Network meta-analysis based on four new oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation

Objective To evaluate the efficacy of apixaban, dabigatran (110 and 150 mg), rivaroxaban, edoxaban (30 and 60 mg) for stroke prevention in patients with non-valvular atrial fibrillation by network meta-analysis. Methods PubMed, EMbase, The Cochrane Library, CBM,CNKI,VIP and WanFang Data were searched for the randomized controlled trials (RCTs) of new oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation from database establishment to August 2017. The obtained literature were analyzed by R3.4.1 software. Results A total of 11 RCTs involving 74 386 patients were included. Compared with warfarin, dabigatran 150 mg could reduce the rate of stroke (OR=0.43, 95%CI: 0.12~0.81, P<0.05). The results of area under the cumulative ranking curve which ranked effectiveness of all thrombolytics for stroke prevention showed that dabigatran 150 mg had the best effectiveness and edoxaban 30 mg had the worst effectiveness. In term of other rank was apixaban, rivaroxaban, dabigatran 110 mg, edoxaban 60 mg, and warfrain. Conclusions Dabigatran 150 mg is the optimal choice for prevention of stroke in patients with non-valvular atrial fibrillation, followed by apixaban, rivaroxaban, dabigatran 110 mg, edoxaban 60 mg, warfarin and edoxaban 30 mg. This experiment provides reference for rational drug use in clinical setting.