The Pharmacy Read List: March 2nd Edition

We’re happy to announce that this week we have an extra edition of the Read List, by a guest contributor, Timothy Lim! Timothy is a fellow pharmacy student at the UBC Faculty of Pharmaceutical Sciences. In his contribution, he describes a meta-analysis comparing new oral anticoagulants with warfarin in atrial fibrillation that uses Bayesian statistics to analyze its findings. We think that Timothy does a good job at simplifying it down to the bottom line so have a read below.

In other news, the winner of last month’s quiz is Chase Fisher! Congratulations for being our randomly-drawn winner of a $10 Starbucks gift certificate! You will be contacted shortly by email with your prize.

The Read List is (usually) a biweekly update on pharmaceutical literature. Every two weeks we handpick one of the most relevant and interesting pharmacy-related publications and summarize it for your convenience. At the end of every month, a quiz on that month’s content will be released. Simply take the quiz, and you’ll be automatically entered into a draw for a gift card prize!.

Instructions to access: 

  • access PubMed via: http://guides.library.ubc.ca/pharmacy 
  • enter “Efficacy and safety of non-vitamin K oral anticoagulants in non-valvular atrial fibrillation: a Bayesian meta-analysis approach”

Efficacy and safety of non-vitamin K oral anticoagulants in non-valvular atrial fibrillation: a Bayesian meta-analysis approach

Atrial fibrillation (AF) is a common arrhythmia associated with an increased risk of embolic stroke and mortality. For years, the only available oral anticoagulant for stroke and systemic embolism prevention in AF patients was a Vitamin K Antagonist such as warfarin—up until recently. The development of novel oral anticoagulants (NOACs) within recent years have challenged warfarin as worthy alternatives in stroke prevention. This meta-analysis attempts to rank treatments in terms of safety and efficacy profiles using Bayesian statistical methods. Through a systematic literature search for randomized controlled Phase III non-inferiority clinical trials that compared warfarin with NOACs in patients with non-valvular AF using MEDLINE, ISI Web of Knowledge and SCOPUS, four studies (ROCKET-AF, ARISTOTLE, ENGAGE AG-TIMI, and RE-LY) were acquired. Bayesian mixed treatment comparisons were conducted to determine the safety and efficacy outcomes of the NOACs and warfarin, along with a 95% credible interval for odds ratio. Efficacy outcomes included stroke and systemic embolism, while safety outcomes entailed various kinds of bleeding (e.g. major, intracranial and gastrointestinal). The NOACs included in the meta-analysis are: Dabigatran 110mg and 150mg, Rivaroxaban 20mg, Apixaban 5mg BID, and Edoxaban 30mg and 60mg. The analysis between NOACs did not reveal any major differences since none were able to rank best or worst for both safety and efficacy parameters. For instance, Edoxaban 30mg had the lowest probability of major and GI bleeds (i.e. best safety outcomes), but ranked worst in stroke prevention (i.e. poor efficacy outcomes). Markedly, with regards to any safety and efficacy outcomes, the probability of warfarin ranking first was nil—overall, being associated with the worst safety and efficacy profile. Though limitations such as indirect comparisons of the phase III trials affecting Bayesian statistical methods, this meta-analysis provides pharmacists with a plethora of information when choosing the right anticoagulation for stroke prevention in non-valvular AF patients. Selection of drug must cater to the patient profile—each NOAC has specific safety and efficacy features that make it favourable over another. Nonetheless, it appears these NOACs will serve with increasing utility in anticoagulation therapy for non-valvular AF stroke prevention.

– Timothy Lim
B.Sc. (Pharm) Candidate 2016

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