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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).
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.
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