Oral Direct Thrombin Inhibitors For Prevention Of Stroke In Patients With Atrial Fibrillation:a Systematic Review

Objective:To evaluate the efficacy and safety of oral direct thrombin inhibitors compared with conventional drugs in preventing stroke and systemic embolism in patients with atrial fibrillation.Methods:We systematically searched CENTRAL, Embase and Pubmed to identify possible randomized controlled trials about oral direct thrombin inhibitors therapy on nonvalvular atrial fibrillation. The methodological quality of the trials was evaluated by the criteria methods recommended from Cochrane, a meta-analysis was carried out using Cochrane RevMan5.1software.Results:Ten studies involving a total of27751participants were included. Oral direct thrombin inhibitors were better than warfarin for preventing stroke and systemic embolism (relative risk (RR)=0.84,95%C10.72to0.97, P=0.002), particularly for reducing intracranial hemorrhage (RR=0.42,95%Cl:0.32to0.56; p<0.00001for superiority) and hemorrhagic stroke (RR=0.32,95%Cl:0.21to0.50; p<0.00001for superiority), and major bleeding (RR=0.84,95%Cl:0.76to0.94, p-0.002). In addition, RR reductions were observed in favor of oral direct thrombin inhibitors compared with warfarin for any bleeding events (21%,95%CI:17%to25%, p<0.00001) and for fatal bleeding (RR=0.67,95%CI:0.45to0.99, p=0.005). But no significant difference between the two groups was observed for all-cause mortality (RR=0.92,95%CI:0.83to1.00, p=0.06), for clinically relevant non-major bleeding (RR=0.69,95%CI:0.38to1.29, p=0.25) and myocardial infarction (RR=1.19,95%CI:0.75to1.87, p=0.46).Conclusion:There is some evidence suggest oral direct thrombin inhibitors had better efficacy and safety than warfarin in preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation. However, further studies are needed to confirm these findings.