Evidence map›Paper›PMID 42547732›Full record

SynthesisInternal and emergency medicine2026

Effects of direct oral anticoagulants on cardiac outcomes in atrial fibrillation: a systematic review and network meta-analysis.

Danilo Menichelli, Daniele Malatesta, Arianna Pannunzio, Alessio Farcomeni, Francesco Violi, Pasquale Pignatelli, Daniele Pastori

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Internal and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Danilo MenichelliDepartment of General Surgery, Surgical Specialty and Anesthesiology, Sapienza University of Rome, Rome, Italy.
Daniele MalatestaPostgraduate School of Internal Medicine, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
Arianna PannunzioDepartment of General Surgery, Surgical Specialty and Anesthesiology, Sapienza University of Rome, Rome, Italy.
Alessio FarcomeniFaculty of Economics, Tor Vergata University of Rome, 00133, Rome, Italy.
Francesco VioliSapienza University of Rome, Rome, Italy.
Pasquale PignatelliDepartment of Medical and Cardiovascular Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Daniele PastoriDepartment of Medical and Cardiovascular Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. daniele.pastori@uniroma1.it.ORCID http://orcid.org/0000-0001-6357-5213

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDirect oral anticoagulants (DOACs) reduce thromboembolism in atrial fibrillation (AF), but their effect on cardiac outcomes is less studied.

methodsSystematic review and network meta-analysis were performed on AF patients on DOACs/vitamin K antagonists (VKAs). Both observational studies and randomized clinical trials (RCTs) were included. Endpoints were myocardial infarction (MI) and major adverse cardiac events (MACE). Rankograms and SUCRA were performed. Sub-group analysis included age (</≥ 75 years) and length of follow-up (</≥ 12 months).

results50 studies (3 RCTs, 4 post hoc analyses of RCTs and 43 observational studies) with 1,769,987 patients were included (59.9% on DOACs and 45.3% women). The MI risk (46 studies with 1,554,704 patients) was lower in all DOACs compared to VKA (apixaban: hazard ratio [HR] 0.83, 95% credible interval [95%CI 0.72-0.96], edoxaban: HR 0.68, 95%CI 0.53-0.86, rivaroxaban: HR 0.84, 95%CI 0.74-0.95, dabigatran: HR 0.85, 95%CI 0.75-0.97). SUCRA showed edoxaban as first choice for preventing MI overall. In patients aged < 75 years, a lower MI risk was found for edoxaban (HR 0.60, 95%CI 0.41-0.85), while in those aged ≥ 75 years, no significant difference was found among anticoagulants. Heterogeneity was low in all analyses. Network meta-analysis showed no differences among DOACs. Compared to VKA, apixaban (HR 0.77, 95%CI 0.63-0.97) was associated with lower MACE risk. Analysis of SUCRA showed apixaban as first choice for preventing MACE overall and in patients treated for < 12 months.

conclusionDOACs were associated with a lower risk of MACE/MI in AF. The effect of DOACs on cardiovascular risk differs according to aging and follow-up length. However, our findings are based on indirect evidence, and further studies are needed. PROSPERO REGISTRATION NUMBER: CRD42023407778.

Indexed as

AnticoagulantsAtrial FibrillationAdministration, OralAgedFemaleHumansMyocardial InfarctionPyrazolesPyridinesPyridonesRivaroxabanThiazolesThromboembolismVitamin KAnticoagulantsedoxabanPyrazolesPyridinesPyridonesRivaroxabanThiazolesVitamin KApixabanAtrial fibrillationDabigatranDirect oral anticoagulantsEdoxabanElderlyMajor cardiovascular eventsMyocardial infarctionRivaroxabanVitamin K antagonist

Identifiers

PMID42547732
PMCPMC13582121

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.