Efficacy And Safety Of Dabigatran And Rivaroxaban In Patients With Nonvalvular Atrial Fibrillation :a Meta-Analysis

Background:We aimed to explore the efficacy and safety of dabigatran and rivaroxaban during anticoagulant therapy in patients with Nonvalvular atrial fibrillation.Methods: PubMed,Embase,The Cochrane Library and Chinese database were used to obtain the efficacy and safety of dabigatran and rivaroxaban in patients with NVAF.Efficacy events include ischemic stroke or systemic embolism,myocardial infarction and all-cause death.Safety events include intracranial hemorrhage,gastrointestinal bleeding,severe bleeding and any bleeding.STATA 12.0 was used for statistical analysis,and the relative risk(RRs)and 95% confidence interval(CI)were calculated to represent the combined effect.The results of P <0.05 indicate the difference statistically significant.Results: This study included 14 cohort studies,one small sample RCT study,with a follow-up time of 90 days to 2.5 years.Rivaroban had a lower risk of ischemic stroke or systemic embolism than dabigatran(RR:1.273;95%CI:1.154-1.416;P=0.000).In terms of safety,rivaroban increased intracranial hemorrhage(RR: 0.607;95%CI: 0.508-0.725;P= 0.000)and the risk of gastrointestinal bleeding(RR:0.379;95%CI:0.733-0.849;P=0.000).No differenceswere observed in all-cause death,myocardial infarction,severe bleeding and any bleeding events.Subgroup analysis based on follow-up time showed that the risk of ischemic stroke or systemic embolization was significantly lower in the rivaroxaban group than dabigatran in a follow-up of ≥12 months(RR: 1.33;95%CI:1.18-1.50),but at the same time rivaroxaban had a higher risk of intracranial hemorrhage(RR:0.64;95%CI:0.47-0.85)and gastrointestinal bleeding(RR:0.84;95%CI:0.73-0.96).At the time of anticoagulation time <6 months,rivaroxaban had a higher risk of intracranial hemorrhage(RR:0.53;95%CI: 0.41-0.69),gastrointestinal bleeding(RR:0.75;95%CI:0.68-0.83)and severe bleeding(RR:0.63;95%CI: 0.47-0.84).Conclusion: During ≥12 months of anticoagulant therapy,rivaroxaban is superior to dabigatran in reducing the risk of ischemic stroke or systemic embolism,but at the same time increases the intracranial hemorrhage and gastrointestinal bleeding risk.During <6 months of anticoagulant therapy,rivaroxaban has more risk of intracranial hemorrhage,gastrointestinal bleeding and severe bleeding than dabigatran.