Article type
Year
Abstract
Background:
Atrial fibrillation is a heart condition affecting approximately 92,000 people in Scotland. Direct oral anti-coagulants (DOACs) are prescribed to treat atrial fibrillation. Healthcare Improvement Scotland was asked to conduct a rapid review comparing the clinical effectiveness and safety of DOACs for non-valvular atrial fibrillation to inform discussions on national prescribing of DOACs.
Objectives:
To produce a rapid review to support informed decision-making on national prescribing of DOACs in Scotland
Methods:
No direct comparisons between DOACs were found. A systematic search of Medline and Embase databases identified indirect treatment comparisons. Indirect comparisons were synthesised for two key outcomes:
• Prevention of stroke and systemic embolism
• Major bleeding, intra-cranial haemorrhage and GI bleeding (safety)
Relative risk, absolute risk and SUCRA rankings were reported if they could be extracted from the indirect comparisons.
Results:
Seven indirect comparisons were included. There was considerable overlap of RCTs in these indirect comparisons, which was not addressed in the review.
No standardised methodology for rapid reviews of indirect comparisons was identified. Therefore a pragmatic systematic approach to evidence synthesis was employed. Only comparisons including all four DOACs of interest were selected. Effect estimates and confidence intervals for each comparison were reported from the best quality indirect comparison for the outcome.
Clinical effectiveness and safety effect estimates for individual DOACs were consistent across indirect comparisons, which increased confidence in the results of the review. The review made no recommendations on which DOAC(s) should be prescribed in Scotland. A national prescribing group of clinical experts and decision-makers decided which DOACs to pursue nationally.
Conclusions:
The rapid review was well received by the prescribing group that requested it and informed discussions with the pharmaceutical industry. Future reviews of indirect comparisons could apply similar approaches. Implications of synthesising indirect comparisons that include the same RCTs should be considered.
Patient or healthcare consumer involvement:
The review was used to inform national prescribing decisions to improve DOAC prescribing in Scotland.
Atrial fibrillation is a heart condition affecting approximately 92,000 people in Scotland. Direct oral anti-coagulants (DOACs) are prescribed to treat atrial fibrillation. Healthcare Improvement Scotland was asked to conduct a rapid review comparing the clinical effectiveness and safety of DOACs for non-valvular atrial fibrillation to inform discussions on national prescribing of DOACs.
Objectives:
To produce a rapid review to support informed decision-making on national prescribing of DOACs in Scotland
Methods:
No direct comparisons between DOACs were found. A systematic search of Medline and Embase databases identified indirect treatment comparisons. Indirect comparisons were synthesised for two key outcomes:
• Prevention of stroke and systemic embolism
• Major bleeding, intra-cranial haemorrhage and GI bleeding (safety)
Relative risk, absolute risk and SUCRA rankings were reported if they could be extracted from the indirect comparisons.
Results:
Seven indirect comparisons were included. There was considerable overlap of RCTs in these indirect comparisons, which was not addressed in the review.
No standardised methodology for rapid reviews of indirect comparisons was identified. Therefore a pragmatic systematic approach to evidence synthesis was employed. Only comparisons including all four DOACs of interest were selected. Effect estimates and confidence intervals for each comparison were reported from the best quality indirect comparison for the outcome.
Clinical effectiveness and safety effect estimates for individual DOACs were consistent across indirect comparisons, which increased confidence in the results of the review. The review made no recommendations on which DOAC(s) should be prescribed in Scotland. A national prescribing group of clinical experts and decision-makers decided which DOACs to pursue nationally.
Conclusions:
The rapid review was well received by the prescribing group that requested it and informed discussions with the pharmaceutical industry. Future reviews of indirect comparisons could apply similar approaches. Implications of synthesising indirect comparisons that include the same RCTs should be considered.
Patient or healthcare consumer involvement:
The review was used to inform national prescribing decisions to improve DOAC prescribing in Scotland.