The Efficacy and Safety of 3 Types of Interventions for Stroke Prevention in Patients With Cardiovascular and Cerebrovascular Diseases: A Network Meta-analysis

Abstract Purpose The goal of this study was to compare the relative efficacy and safety of different types of interventions for stroke prevention in patients with cardiovascular and cerebrovascular diseases. Methods This network meta-analysis (NMA) was conducted with a random effects model of Bayesi...

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Bibliographic Details
Published in:Clinical therapeutics 2017-07, Vol.39 (7), p.1291-1312.e8
Main Authors: Sun, Qian, MD, Chang, Shumei, BD, Lu, Songtao, MD, Zhang, Yajing, BD, Chang, Yajun, MD
Format: Article
Language:English
Subjects:
Anticoagulants
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
antiplatelet
Arteriosclerosis
Aspirin
Aspirin - adverse effects
Aspirin - therapeutic use
Atherosclerosis
Bayes Theorem
Bayesian analysis
Cardiac arrhythmia
cardiovascular and cerebrovascular disease
Cardiovascular disease
Cardiovascular Diseases - drug therapy
Cardiovascular Diseases - prevention & control
Cerebral infarction
Cerebrovascular diseases
Clinical trials
Clopidogrel
Dabigatran - adverse effects
Dabigatran - therapeutic use
Dipyridamole
Dipyridamole - adverse effects
Dipyridamole - therapeutic use
Diseases
Effectiveness
Fibrillation
Hemorrhage
Hemorrhage - chemically induced
Humans
Internal Medicine
intracranial hemorrhage
Ischemia
Medical Education
medical interventions
Meta-analysis
Mortality
Myocardial infarction
network meta-analysis
Odds Ratio
Patients
Prevention
Pyrazoles - adverse effects
Pyrazoles - therapeutic use
Pyridines - adverse effects
Pyridines - therapeutic use
Pyridones - adverse effects
Pyridones - therapeutic use
Randomized Controlled Trials as Topic
Ranking
Safety
statins
Stroke
Thiazoles - adverse effects
Thiazoles - therapeutic use
Ticlopidine
Ticlopidine - adverse effects
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
Treatment Outcome
Vascular diseases
Warfarin
Warfarin - adverse effects
Warfarin - therapeutic use
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Summary:Abstract Purpose The goal of this study was to compare the relative efficacy and safety of different types of interventions for stroke prevention in patients with cardiovascular and cerebrovascular diseases. Methods This network meta-analysis (NMA) was conducted with a random effects model of Bayesian framework using Stata version 12.0. Odds ratios (ORs) and their credible intervals (CrIs) were applied for the efficacy and safety evaluation of various medical interventions, including aspirin, dipyridamole, ticlopidine, warfarin, and apixaban. In addition, the ranking of probability of every clinical outcome was estimated by comparing the surface under the cumulative ranking curve. Findings Compared with dabigatran, both edoxaban and aspirin + warfarin exhibited a higher rate of all-cause stroke (OR, 2.84 [95% CrI, 1.17–6.97]; OR, 3.42 [95% CrI, 1.20–9.84]). With respect to intracranial hemorrhage, aspirin + clopidogrel yielded worse outcomes than 7 treatments, including placebo, apixaban, aspirin, aspirin + dipyridamole, cilostazol, clopidogrel, and dabigatran (OR, 2.21 [95% CrI, 1.45–3.40]; OR, 2.11 [95% CrI, 1.05–4.17]; OR, 1.53 [95% CrI, 1.11–2.15]; OR, 1.78 [95% CrI, 1.01–3.03]; OR, 4.17 [95% CrI, 1.37–14.28]; OR, 1.85 [95% CrI, 1.22–2.86]; and OR, 2.56 [95% CrI, 1.37–4.76]). In terms of ischemic stroke, dabigatran provided better efficacy than placebo, aspirin, and aspirin + dipyridamole (OR, 0.36 [95% CrI, 0.18–0.72]; OR, 0.43 [95% CrI, 0.21–0.84]; and OR, 0.41 [95% CrI, 0.17–0.94]). As for mortality, dabigatran resulted in a lower mortality compared with aspirin, aspirin + clopidogrel, edoxaban, and warfarin (OR, 0.48 [95% CrI, 0.23–0.97]; OR, 0.40 [95% CrI, 0.17–0.92]; OR, 0.27 [95% CrI, 0.10–0.72]; and OR, 0.52 [95% CrI, 0.28–0.92]). Implications There are still some limitations to our NMA research. For instance, the lack of direct evidence for some therapies resulted in inconsistencies, particularly for warfarin compared with placebo and clopidogrel under different end points. Moreover, the included randomized controlled trials for patients with cardiovascular and cerebrovascular diseases are relatively broad, involving atrial fibrillation, myocardial infarction, and large-artery atherosclerosis stroke. Although further research is needed, dabigatran is highly recommended based on the present NAM for the treatment of cardiovascular and cerebrovascular diseases due to the drug’s efficacy and safety.
ISSN:0149-2918
1879-114X
DOI:10.1016/j.clinthera.2017.04.008