Comparative efficacy and safety of anticoagulant therapies in coronary artery disease: a network meta-analysis of randomized controlled trials

The most efficacious anticoagulant intervention for people with coronary artery disease (CAD) is still not clearly defined, highlighting the need for a comprehensive assessment of the available alternatives. Previous studies have assessed individual treatments, but a lack of integrated comparisons limits clinical decision-making. This investigation seeks to check how safe and effective a range of anticoagulant therapies for individuals suffering from CAD are through a network meta-analysis.

A comprehensive study and NMA were performed, including data from Embase, MEDLINE, PubMed, and WoS through May 20, 2024. 11 RCTs were incorporated, encompassing 118,870 individuals suffering from CAD. Outcome measures focused on stroke, myocardial infarction, all-cause mortality, cardiovascular mortality, and bleeding risks. Effect sizes for categorical variables were measured by odds ratios (OR) with 95% CrIs.

The administration of Rivaroxaban at a dosage of 2.5 mg BID, in conjunction with Aspirin at 100 mg OD, has been shown to markedly diminish the incidence of stroke (OR: 0.56, 95% CrI: 0.48 to 0.66), myocardial infarction (OR: 0.72, 95% CrI: 0.57 to 0.90), all-cause mortality (OR: 0.77, 95% CrI: 0.60 to 0.98), and cardiovascular mortality (OR: 0.77, 95% CrI: 0.66 to 0.90) however, there is an elevated risk of bleeding. The administration of Rivaroxaban in dose of 2.5 mg BID demonstrated elevated SUCRA rankings in terms of both efficacy and safety, indicating a well-rounded profile.

The administration of Rivaroxaban in dose of 2.5 mg BID, in conjunction with Aspirin at 100 mg OD, demonstrates efficacy in mitigating thrombotic occurrences among individuals with CAD; however, it concomitantly elevates the risk of bleeding complications. Administering Rivaroxaban in dose of 2.5 mg two times per day stands as a plausible alternative, achieving a commendable equilibrium between efficacy and safety. This study helps fill an important evidence gap in guiding optimal anticoagulant strategies for CAD patients.