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Cochrane corner
Cochrane corner: NOACs in atrial fibrillation patients post-percutaneous coronary intervention
  1. Samer Al Said1,2,
  2. Hugo A Katus1,2,
  3. Samer Alabed3,4
  1. 1 Department for Internal Medicine III Cardiology Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
  2. 2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
  3. 3 Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, South Yorkshire, UK
  4. 4 Cardiothoracic Radiology, Sheffield Teaching Hospitals, Sheffield, UK
  1. Correspondence to Dr Samer Al Said, University Hospital Heidelberg Department for Internal Medicine III Cardiology Angiology and Pneumology, 69120 Heidelberg, Germany; sameralsaid{at}gmail.com

https://doi.org/10.1136/heartjnl-2020-316726

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    Introduction

    One in ten people undergoing percutaneous coronary intervention (PCI) has underlying atrial fibrillation (AF). They are often treated with long-term oral anticoagulation for stroke prevention and are commenced on antiplatelet therapy post-PCI to prevent stent thrombosis.1 A careful balance of risk of bleeding versus thrombosis is essential.

    Options for oral anticoagulation include vitamin K antagonists (VKAs), for example, warfarin, and non‐vitamin K antagonist oral anticoagulants (NOACs), also referred to as direct oral anticoagulants. In contrast to VKA, NOACs directly inhibit either thrombin (dabigatran) or factor X (rivaroxaban, apixaban and edoxaban). Recent randomised controlled trials (RCTs) have compared NOACs with warfarin in patients with AF undergoing PCI. We reviewed these RCTs to summarise their efficacy and safety results.2 One of our aims was also to compare NOACs with each other; however, no RCT conducted such a comparison. We, therefore, performed a network meta-analysis to compare NOACs indirectly. A network meta-analysis is a unique statistical technique that facilitates indirect comparisons of interventions based on a common comparator across trials, that is, warfarin, in our analysis (figure 1).

    Figure 1

    Network diagram for major bleeding. Nodes are weighted according to the number of studies that includes the respective intervention. Edges are weighted according to the number of patients included in the respective comparison. Numbers on the lines represent the number of trials …

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    Footnotes

    • Twitter @smrabd

    • Contributors SAS drafted the manuscript. SA and HAK edited and revised the manuscript for its intellectual content. All authors contributed substantially to this manuscript and have approved the final version.

    • Disclaimer This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2019, Issue12, DOI: 10.1002/14651858.CD013252.pub2 (see www. cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.

    • Competing interests SAS: none declared. HAK: honorary for lecture and consulting: Bayer Vital and Boehringer. SA: none declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.