Direct Anticoagulants and Risk of Myocardial Infarction, a Multiple Treatment Network Meta-Analysis

Péter Kupó, Zsolt Szakács, Margit Solymár, Tamás Habon, László Czopf, Lidia Hategan, Beáta Csányi, János Borbás, Annamária Tringer, Gábor Varga, Márta Balaskó, Róbert Sepp, Péter Hegyi, Alexandra Bálint, András Komócsi

Research output: Article


We assessed the cardiovascular safety of long-term direct-acting oral anticoagulant (DOAC) treatment. A search of the medical literature was performed from inception until May 31, 2019. Inclusion criteria were (1) randomized trial that assessed the clinical efficacy and/or safety of 1 or more DOAC, (2) control group including oral anticoagulation and/or antiplatelet and/or placebo treatment, and (3) the incidence of acute coronary syndrome during follow-up was reported. Fixed-effect and random-effects models were applied. The analyzed outcomes were myocardial infarction (MI), major bleeding, and mortality. Twenty-eight randomized clinical trials (196 761 patients) were included. Rivaroxaban was associated with a 21% reduction in the relative risk of MI when compared to placebo (relative risk [RR]: 0.79 [95% credible interval, CrI: 0.65-0.94]) and a 31% reduction (RR: 0.70 [95% CrI: 0.53-0.89]) when compared to dabigatran. Apixaban resulted in 24% (RR: 0.76 [95% CrI: 0.58-0.99]) and vitamin K antagonists anticoagulation resulted in 19% (RR: 0.81 [95% CrI: 0.65-0.98]) risk reduction compared to dabigatran. The computed probability of being the first best choice of treatment was 61.8% for rivaroxaban. Cardiovascular safety shows considerable heterogeneity among oral anticoagulants. Treatment with rivaroxaban is associated with reduced rate of MI.

Original languageEnglish
Pages (from-to)27-37
Number of pages11
Issue number1
Publication statusPublished - jan. 1 2020


ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kupó, P., Szakács, Z., Solymár, M., Habon, T., Czopf, L., Hategan, L., Csányi, B., Borbás, J., Tringer, A., Varga, G., Balaskó, M., Sepp, R., Hegyi, P., Bálint, A., & Komócsi, A. (2020). Direct Anticoagulants and Risk of Myocardial Infarction, a Multiple Treatment Network Meta-Analysis. Angiology, 71(1), 27-37.