| Background:The novel oral direct factor Xa inhibitor,rivaroxaban hasbeen tested in a series of clinical conditions,It has been proved to be apromising alternative to conventional anticoagulant therapy.Objectives:To asscess the efficacy and safety of rivaroxaban,we performeda systematic review and meta-analyses of all the randomised controlledtrials(RCTs) comparing rivaroxaban to conventional anticoagulant therapy(CAT).Methods: Medline, Embase and The Cochrane Library were searched forpublished studies up to31June2012.The rates of major adverse events (allcause death, nonfatal myocardial infarction,nonfatal thromboembolicstroke, nonfatal pulmonary embolism), major bleeds(MB), andhepatotoxicity were compared.16RCTs with58,136patients(1196patientswere included in two different studies about the treatment of venousthrombosis) were included in this meta-analysis. Indications were:1)venous thromboembolism (VTE) prevention in adult patients undergoingelective hip or knee replacement surgery;2) management of deep venous thrombosis(DVT) or plumonary embolism(PE);3) stroke prevention inatrial fibrillation(AF);4) cardiovascular events prevention in acutecoronary syndrome(ACS).Results: From16RCTs (n=58,136), rivaroxaban showed a lower risk of allcause death(OR0.84,95%CI[0.75,0.95],P=0.005), nonfatal myocardialinfarction(MI)(OR0.81,95%CI [0.71,0.93], P=0.002), hepatotoxicity （OR0.66,95%CI [0.50,0.88], P=0.34）.And the risk of nonfatalthromboembolic stroke(OR0.71,95%CI [0.36,1.42], P=0.004), nonfatalpulmonary embolism(PE)(OR0.85,95%CI [0.60,1.22], P=0.38)and MB（OR1.38,95%CI [0.84,2.28], P=0.21）were noninferior to CAT.Conclusions: In these various clinical conditions, rivaroxaban reduced therisk of all-cause death, nonfatal MI, hepatotoxicity, and did not increase therisk of MB, nonfatal PE or thromboembolic stroke. This information maybe useful to demonstrate that rivaroxaban is an effective and safealternative for anticoagulant therapy. |
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