The research assesses the safety and efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) versus placebo or antiplatelet therapy following acute myocardial infarction (AMI) in patients with no indication for anticoagulation. A systematic review and network meta-analysis of six randomized controlled trials (RCTs) including 33,039 patients compared rivaroxaban, apixaban, and dabigatran. Rivaroxaban lowered all-cause mortality (risk ratio [RR] 0.82) and likely cardiovascular mortality (RR 0.83), and dabigatran had a likely reduction in all-cause mortality but with low-certainty evidence. Apixaban did not affect mortality outcomes.
Substantial bleeding hazards were substantially increased with rivaroxaban (RR 3.31) and apixaban (RR 2.41) versus placebo, but dabigatran was not significantly increased. The network meta-analysis was unclear about the superiority of one NOAC over another. The results indicate that NOACs could have a mortality benefit but with a small effect size, and the hazard of bleeding needs to be carefully balanced. Head-to-head trials are required to determine the best NOAC therapy for post-AMI patients.
Source: www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014678.pub2/full
