Review Article

Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups

Table 4

Direct comparisons for secondary outcomes: absolute difference in events 1000 patients treated per year and NNTB per year*.

Population All strokes and SEEMajor bleeding
ComparisonRisk difference
(95% CI)
NNTB
(95% CI)
Risk difference
(95% CI)
NNTB
(95% CI)

All patients
All NOAC versus warfarin−3.2 (−4.8 to −1.6)310 (207 to 620)−4 (−9 to 1)253 (NNTB 111 to ∞ to NNTH 962)
 Dabigatran versus warfarin−3.7 (−6.5 to −1)269 (154 to 980)−4.4 (−8.4 to −0.5)228 (120 to 2179)
 Rivaroxaban versus warfarin−2.7 (−6 to 0.7)370 (NNTB 166 to ∞ to NNTH 1479)0.7 (−3.2 to 4.5)NNTH 1479 (NNTB 310 to ∞ to NNTH 221)
 Apixaban versus warfarin−3.3 (−5.9 to −0.7)303 (168 to 1374)−8.4 (−11.7 to −5.1)119 (85 to 196)

European population
All NOAC versus warfarin−0.9 (−3.1 to 1.4)1131 (NNTB 321 to ∞ to NNTH 712)−3.0 (−5.7 to −0.3)337 (176 to 3846)
 Dabigatran versus warfarin−0.6 (−4.6 to 3.5)1783 (NNTB 218 to ∞ to NNTH 288)−3.2 (−8.4 to 2.1)316 (NNTB 119 to ∞ to NNTH 467)
 Rivaroxaban versus warfarin−2.3 (−7 to 2.3)437 (NNTB 145 to ∞ to NNTH 437) −2.1 (−6.7 to 2.3)469 (NNTB 150 to ∞ to NNTH 427)
 Apixaban versus warfarin−0.3 (−4 to 3.4)2976 (NNTB 252 to ∞ to NNTH 298)−3.8 (−8.4 to 0.9)263 (NNTB 119 to ∞ to NNTH 1276)

Non-European population
All NOAC versus warfarin−4.9 (−7.1 to −2.7)205 (140 to 377)−4.3 (−12.5 to 3.9)232 (NNTB 80 to ∞ to NNTH 256)
 Dabigatran versus warfarin−5.7 (−9.3 to −2)177 (108 to 503)−5.2 (−10.7 to 0.3)192 (NNTB 94 to ∞ to NNTH 3922)
 Rivaroxaban versus warfarin−3.1 (−8.1 to 1.9)321 (NNTB 123 to ∞ to NNTH 534)4 (−2.6 to 10.5)NNTH 253 (NNTB 385 to ∞ to NNTH 95)
 Apixaban versus warfarin−5.4 (−9 to −1.8)186 (112 to 558)−11.5 (−16.1 to −6.9)87 (62 to 144)

Prior stroke or TIA
All NOAC versus warfarin−3.6 (−7.4 to 0.1)275 (NNTB 135 to ∞ to NNTH 19231)−4.1 (−8.7 to 0.6)247 (NNTB 114 to ∞ to NNTH 1603)
 Dabigatran versus warfarin−5.5 (−13.2 to 2.3)183 (NNTB 76 to ∞ to NNTH 436)−6.3 (−15.8 to 3.1)158 (NNTB 63 to ∞ to NNTH 321)
 Rivaroxaban versus warfarin−1.4 (−6.5 to 3.7)712 (NNTB 154 to ∞ to NNTH 271)−1 (−6 to 4.1)1012 (NNTB 166 to ∞ to NNTH 243)
 Apixaban versus warfarin−7.4 (−15.5 to 0.7)135 (NNTB 64 to ∞ to NNTH 1374)−8.6 (−17 to −0.2)116 (59 to 4464)

No prior stroke or TIA
All NOAC versus warfarin−2.9 (−4.6 to −1.2)350 (219 to 836)−3.5 (−9.1 to 2)283 (NNTB 111 to ∞ to NNTH 506)
 Dabigatran versus warfarin−3.3 (−6.2 to −0.5)302 (162 to 1961)−3.9 (−3.2 to 0.4)255 (NNTB 316 to ∞ to NNTH 2451)
 Rivaroxaban versus warfarin−4.3 (−8.5 to 0)235 (117 to ∞)2.6 (−3.4 to 8.5)NNTH 392 (NNTB 291 to ∞ to NNTH 118)
 Apixaban versus warfarin−2.2 (−4.8 to 3.0)446 (NNTB 208 to ∞ to NNTH 2976)−8.3 (−11.9 to −0.5)121 (84 to 213)

TTR ≥ 65%
All NOAC versus warfarin−2.6 (−4.8 to −0.4)385 (207 to 2404)−0.6 (−6.6 to 7.7)NNTH 1748 (NNTB 153 to ∞ to NNTH 130)
 Dabigatran versus warfarin−2 (−5.7 to 1.6)490 (NNTB 177 to ∞ to NNTH 633)0.1 (−5.4 to 5.7)NNTH 9804 (NNTB 185 to ∞ to NNTH 177)
 Rivaroxaban versus warfarin−4.2 (−9.7 to 1.3)240 (NNTB 103 to ∞ to NNTH 769)9.1 (0.2 to 17.9)NNTH 111 (56 to 4808)
 Apixaban versus warfarin−2.7 (−6.1 to 0.7)372 (NNTB 165 to ∞ to NNTH 1488)−5.4 (−10.4 to −0.4)186 (97 to 2551)

TTR < 65%
All NOAC versus warfarin−4 (−6.2 to −1.9)250 (162 to 534)−7.1 (−12.7 to −1.6)140 (78 to 641)
 Dabigatran versus warfarin−5.3 (−9.4 to −1.2)189 (107 to 853)−8.8 (−14.4 to −3.2)113 (69 to 316)
 Rivaroxaban versus warfarin−3.3 (−6.9 to 0.2)300 (NNTB 146 to ∞ to NNTH 6410)−2 (−6.3 to 2.3)493 (NNTB 159 to ∞ to NNTH 437)
 Apixaban versus warfarin−4 (−8 to 0)252 (126 to ∞)−11.4 (−15.8 to −7)88 (63 to 143)

Random effects model, intention-to-treat.
NA: data not available; NNTB: number of patients needed to be treated for one additional patient to benefit; NNTH: number of patients needed to be treated for one additional patient to be harmed; NOAC: new oral anticoagulants; SEE: systemic embolic event; TIA: transient ischemic attack; TTR: time in therapeutic range.