EFFICACY AND SAFETY OF NEW ANTICOAGULANTS IN THE TREATMENT OF ATRIAL FIBRILLATION- A HEALTH TECHNOLOGY ASSESSMENT

Author(s)

Buehler AM*;Suzumura EA;Figueiró MF;Cavalcanti AB, Berwanger O Hospital do Coração, São Paulo, Brazil

INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Patients with AF have a 4-5 times larger risk of stroke than age-matched controls. Anticoagulation with warfarin is currently the standard of care but the requirement for routine monitoring and drug and food interactions, makes its use is suboptimal. New anticoagulants were developed to eliminate these barriers and the results are promising. However, the incorporation of these technologies within the Brazilian Unified Health System (SUS) demands proper consideration. OBJECTIVES: To evaluate the efficacy and safety of new anticoagulants in the treatment of AF. METHODS: Health Technology Assessment of multiple technologies. We searched the electronic databases Cochrane Library, CRD, Pubmed, Embase and Lilacs, to search for the best available evidence assessing the new oral anticoagulants, compared with warfarin in patients with AF. RESULTS: Three randomized controlled trials evaluating dabigatran (110mg e 150mg), rivaroxaban 20mg and apixaban 5mg were included, all of them compared with warfarin. In this regard, dabigatran 110mg was associated with similar rates of stroke or systemic embolism and with a 20% relative risk reduction (RRR) of major hemorrhage compared with warfarin. Dabigatran 150mg was associated with a 34% RRR of stroke or systemic embolism and similar rates of major hemorrhage. Rivaroxaban 20mg was associated with similar rates of the primary efficacy and safety outcomes. Finally, apixaban was associated with a 21% RRR of stroke or systemic embolism and with 31% RRR of major bleeding compared with warfarin. CONCLUSIONS: There is strong evidence supporting these new technologies, especially regarding safety. Further studies are needed to support decision making, especially with regards to cost-effectiveness issues.

Conference/Value in Health Info

2013-09, ISPOR Latin America 2013, Buenos Aires, Argentina

Value in Health, Vol. 16, No. 7 (November 2013)

Code

HT1

Topic

Health Technology Assessment

Topic Subcategory

Decision & Deliberative Processes

Disease

Cardiovascular Disorders, Respiratory-Related Disorders

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