Gastrointestinal Safety Profiles Differ Among Non-Vitamin K Antagnosist Anticoagulants? Evidence From Network Meta-Analysis

Background: There is still controversy as to whether the gastrointestinal safety profiles was different among new oral anticoagulation(NOAC).Therefore,we performed a network meta-analysis to evaluate the gastrointestinal bleeding(GI)risk in treating patients with NOACs.Methods: We performed a systematic search of Pub Med,Medline,Cochran Library,Web of science,China national knowledge infrastructure and China biology medicine disc.Randomized controlled trials(RCTs)that evaluated exposure to NOACs(dabigatran,rivaroxaban,apixaban and edoxaban)were included.The primary endpoint was major GI event.A fixed-effect Bayesian model was used to calculated the pooled estimated.All outcomes were expressed as the OR and corresponding 95% credible interval(CrI).Results: Twenty-four RCTs including 139,392 patients were identified.When rivaroxaban and dabigatran were compared with conventional anticoagulants,the pooled results were favorable for conventional anticoagulants(OR,1.41;95%CrI,1.19–1.67 for rivaroxaban;OR,1.27;95% CrI,1.04–1.56 for dabigatran,respectively).Relative to rivaroxaban,apixaban(OR,0.57;95% CrI,0.43–0.77)and edoxaban(OR,0.65;95% CrI,0.51–0.83)were associated with decreased risk of major GI bleeding.Similarly,apixaban(OR,0.64;95% CrI,0.47–0.86)and edoxaban(OR,0.72;95% CrI,0.56–0.94)were associated with a lower major GI bleeding risk than dabigatran.No difference was found between apixaban and edoxaban(OR,0.88;95% CrI,0.66–1.18).Similarly,no difference was observed between rivaroxaban and dabigatran(OR,1.11;95% Cr I,0.86–1.44).Conclusions: Evidence suggests that the gastrointestinal safety profiles was different among NOAC.Apixaban and edoxaban had the most favorable GI safety profile and rivaroxaban and dabigatran the least favorable GI safety profile.The risk of gastrointestinal bleeding needs to be taken into account when prescribing NOAC.