Comparative Effectiveness and Safety of Direct Oral Anticoagulants: Overview of Systematic Reviews

Emanuel Raschi (), Matteo Bianchin, Milo Gatti, Alessandro Squizzato and Fabrizio De Ponti
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Emanuel Raschi: University of Bologna
Matteo Bianchin: University of Bologna
Milo Gatti: University of Bologna
Alessandro Squizzato: University of Insubria
Fabrizio De Ponti: University of Bologna

Drug Safety, 2019, vol. 42, issue 12, No 3, 1409-1422

Abstract: Abstract Direct oral anticoagulants are now recommended by major guidelines as first-choice agents for both stroke prevention in non-valvular atrial fibrillation and treatment/prevention of venous thromboembolism in non-cancer patients. Although there are no published head-to-head trials comparing different direct oral anticoagulants, a growing body of evidence from indirect comparisons and observational studies is suggesting that each direct oral anticoagulant may have a specific risk profile. This review aims to (1) synthesize and critically assess the latest evidence in comparative effectiveness and safety research in the aforementioned consolidated therapeutic uses, by performing an overview of systematic reviews and (2) highlight current challenges, namely underexplored areas, where research should be directed, also considering ongoing unpublished studies. The evidence gathered so far on the risk–benefit profile of direct oral anticoagulants is appraised in the light of existing guidelines to discuss whether further implementation should be proposed.

Date: 2019
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DOI: 10.1007/s40264-019-00866-7

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