A systematic review and meta-analysis was conducted retrieving data from PubMed, SCOPUS and Web of Science from January 2009 to December 2021. Studies that evaluated
apixaban (intervention) prescribed for adults (aged 18 years or older) with AF for
stroke prevention compared to other DOACs or VKAs were identified. Primary outcomes included
stroke/systemic
embolism (SE), all-cause mortality, and major
bleeding. Secondary outcomes were intracranial haemorrhage (ICH) and
ischaemic stroke. Randomised controlled trials and non-randomised trials were considered for inclusion.
RESULTS: In total, 67 studies were included, and 38 studies were meta-analysed. Participants taking
apixaban had significantly lower
stroke/SE compared to patients taking VKAs (relative risk (RR) 0.77, 95% confidence interval (CI) 0.64-0.93, I2 = 94%) and
dabigatran (RR 0.84, 95% CI 0.74-0.95, I2 = 66%), but not to patients administered
rivaroxaban. There was no statistical difference in mortality between
apixaban and VKAs or
apixaban and
dabigatran. Compared to patients administered
rivaroxaban, participants taking
apixaban had lower mortality rates (RR 0.83, 95% CI 0.71-0.96, I2 = 96%).
Apixaban was associated with a significantly lower risk of major
bleeding compared to VKAs (RR 0.58, 95% CI 0.52-0.65, I2 = 90%),
dabigatran (RR 0.79, 95% CI 0.70-0.88, I2 = 78%) and
rivaroxaban (RR 0.61, 95% CI 0.53-0.70, I2 = 87%).
CONCLUSIONS: