| ABSTRACT Objective:To evaluate the efficacy and safety of any of the novel oral anticoagulants (NOACs) in acute coronary syndromes. Methods:We searched PubMed, Embase, Medline, Cochrane Library, SinoMed, wanFang Data, VIP, CNKI and the Chinese Clinical Trial Register to collect randomized controlled trials (RCTs) of the NOACs for acute coronary syndromes from the inception of these databases to December 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta analysis was performed by RevMan 5.3 software.Results:A total of 10 RCTs involving 38 882 patients with acute coronary syndrome were included. The result of Meta analysis showed: compared with antiplatelet therapy group, the addition of a new oral anticoagulant to antiplatelet decreased the incidence of ischemic events [RR=0.86, 95%CI (0.80, 0.93), P=0.000 2], but bleeding events were significantly increased, TIMI bleeding events [RR=2.08, 95%CI (1.79, 2.41), P＜0.000 01], ISTH bleeding events [RR=2.15, 95%CI (1.56, 2.96), P＜0.000 01]. Compared with antiplatelet therapy group, rivaroxaban and ximelagatran decreased ischemic events, but there were no decrease in efficacy event rates with apixaban, dabigatran, darexaban and TAK 442.Conclusion:Compared with antiplatelet therapy, in patients with a recent acute coronary syndrome, the addition of a new oral anticoagulant to antiplatelet therapy results in a modest reduction in ischemic events but a substantial increase in bleeding. The efficacy of different new oral anticoagulants was not consistent compared with antiplatelet therapy. In clinical practice, the risk of hemorrhage and ischemia should be fully assessed and individualized administration should be carried out. |
