Tawfik A, et al. – This meta–analysis aimed to determine the comparative effectiveness of all antithrombotic treatments for atrial fibrillation (AF) patients. In AF patients, all oral anticoagulants reduced the risk of stroke. Compared to warfarin, some novel oral anticoagulants were correlated with a lower stroke and/or major bleeding risk. In addition to the safety and effectiveness of drug therapy, individual treatment recommendations had to consider the patient's underlying stroke and bleeding risk profile.

• The physicians gathered data from Medline Ovid (1946 to October 2015), Embase Ovid (1980 to October 2015), and the Cochrane Central Register of Controlled Trials (­CENTRAL, Issue 9, 2015).
• They selected randomized controlled trials of AF patients if they compared at least two of the following: placebo, aspirin, aspirin, and clopidogrel combination therapy, adjusted-dose warfarin (target international normalized ratio 2.0-3.0), dabigatran, rivaroxaban, apixaban, and edoxaban.
• They conducted Bayesian network meta-analyses for outcomes of interest (all stroke, ischemic stroke, myocardial infarction, overall mortality, major bleeding, and intracranial hemorrhage).

• Compared to antiplatelet agents, all oral anticoagulants were more effective at reducing the risk of ischemic stroke and all strokes based on 16 randomized controlled trials of 96,826 patients.
• Dabigatran 150 mg (rate ratio 0.65, 95% credible interval 0.52-0.82) and apixaban (rate ratio 0.82, 95% credible interval 0.69-0.97) reduced the risk of all strokes compared to warfarin.
• Also, dabigatran 150 mg was more effective than warfarin at reducing ischemic stroke risk (rate ratio 0.76, 95% credible interval 0.59-0.99).
• Compared to warfarin, aspirin, apixaban, dabigatran 110 mg, and edoxaban were associated with less major bleeding.