Journal Club Summary
Methodology Score: 4.5/5
Usefulness Score: 3/5
Dentali F, Riva N, Crowther M, Turpie AG, Lip GY, Ageno W.
Circulation. 2012 Nov 13;126(20):2381-91.
This was a systematic review and meta-analysis of 12 phase II/III RCTs which found that using New Oral Anticoagulants (NOACs: dabigatran, rivaroxaban, apixaban, edoxaban) over warfarin in patients with AF reduced total (ARR 0.4%) and cardiovascular mortality; stroke/systemic embolism, with a trend towards reduced bleeding. The analysis was dominated by 3 main trials and JC attendees noted that some authors of this review were employed by pharmaceutical companies. Despite the high quality methods of this meta-analysis, JC attendees were split over prescribing NOACs in the ED given the lack of reversal agent/antidote and potential complications of major bleeding.
By: Dr. Gauri Ghate
(Presented January 2014)
Epi lesson: PRISMA Statement for Reporting Systematic Reviews
The PRISMA statement (revised 2009 to replace QUORUM http://www.prisma-statement.org) was developed by an international group to establish preferred reporting guidelines for systematic reviews and meta-analyses. David Moher of the Ottawa Hospital Research Institute is the lead author on the paper (www.bmj.com/content/339/bmj.b2535.full) that includes the PRISMA 27-item checklist and four-phase flow diagram.
By: Dr. Ian Stiell