Lower dose direct oral anticoagulants and improved survival: A combined analysis in patients with established atherosclerosis: European Journal of Internal Medicine

R. Cappato, M. Chiarito, M. Giustozzi, M. Briani, H. Ali, L. Riva, G. Bonitta, C. Lodigiani, F. Furlanello, C. Balla, P. Lupo, G. Stefanini

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Antithrombotic/anticoagulation effects of direct oral anticoagulants (DOACs) are dose-dependent. However, recent observations suggest that administering lower dose DOACs may better protect against all-cause mortality. We investigated whether, in patients with established atherosclerosis, DOAC dose selection would affect the risk of all-cause mortality. Methods: We performed a structured literature research for controlled trials allowing random assignment to a lower dose DOAC, a higher dose DOAC, or control therapy in patients with established atherosclerosis. Pooled risk ratios (RRs) of all-cause mortality in lower and higher dose DOACs versus control therapy were estimated using a random-effect model. Results: Atherosclerosis manifested as acute coronary syndrome (n=17,220), stable coronary (CAD) and/or peripheral artery disease (PAD) (n=27,395) or CAD associated with atrial fibrillation (n=4,510). Antithrombotic doses of rivaroxaban (2.5 mg or 5.0 mg BID) or dabigatran (50 mg, 75 mg, 110 mg, or 150 mg, BID) were tested in three trials versus single or dual antiplatelet control therapy, whereas anticoagulation doses of edoxaban (30 mg or 60 OD) were tested versus warfarin in one trial. Compared to control, patients receiving lower dose (RR 0.80, 95% CI 0.73-0.89, p
Original languageEnglish
Pages (from-to)14-20
Number of pages7
JournalEur. J. Intern. Med.
Volume83
DOIs
Publication statusPublished - 2021

Keywords

  • Atherosclerosis
  • Atrial fibrillation
  • Coronary artery disease
  • Direct oral anticoagulants
  • anticoagulant agent
  • dabigatran
  • edoxaban
  • rivaroxaban
  • warfarin
  • acute coronary syndrome
  • adult
  • aged
  • all cause mortality
  • anticoagulation
  • Article
  • atherosclerosis
  • atrial fibrillation
  • comparative study
  • coronary artery disease
  • dual antiplatelet therapy
  • female
  • human
  • male
  • meta analysis
  • peripheral occlusive artery disease
  • risk assessment
  • sensitivity analysis
  • survival
  • systematic review

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