Indirect Comparison of Novel Oral Anticoagulants in Women with Nonvalvular Atrial Fibrillation

J Womens Health (Larchmt). 2017 Mar;26(3):214-221. doi: 10.1089/jwh.2016.5892. Epub 2016 Nov 21.


Background: For nonvalvular atrial fibrillation (NVAF), novel oral anticoagulants (NOACs) have been found noninferior to warfarin for stroke/systemic embolization prevention, and major bleeding events. Recent meta-analysis of NOACs versus warfarin in atrial fibrillation (AF) showed that women on warfarin have greater risk of stroke/embolism than men, and when both are treated with NOACs, differences disappear.

Methods: NOACs differ in pharmacologic properties, thus they may differ from one another in their effects on women with AF. Using dose-adjusted warfarin as the common comparator, an indirect comparison of rivaroxaban, apixaban, dabigatran 110 and 150 mg, and edoxaban 30 and 60 mg for efficacy (stroke/embolism prevention) and safety (major bleeding events) in women with AF was performed. Data from ROCKET-AF, RE-LY, ENGAGE AF TIMI, and ARISTOTLE were analyzed and compared according to the Bucher method.

Results: No significant difference was found for any NOAC compared with alternatives in safety or efficacy for women with AF. Examination of odds ratio comparisons alone showed possible favorable efficacy in dabigatran 150 mg, and unfavorable efficacy with favorable safety in edoxaban 30 mg.

Conclusion: NOACs may slightly differ in their effect in women; the potential differences are very small and likely clinically negligible. Thus, NOACs can be used interchangeably in women according to patient and physician preferences to increase adherence.

Keywords: anticoagulation; arrhythmia; atrial fibrillation; gender; women.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Dabigatran / adverse effects
  • Dabigatran / therapeutic use
  • Female
  • Hemorrhage / etiology
  • Humans
  • Odds Ratio
  • Pyrazoles / adverse effects
  • Pyrazoles / therapeutic use
  • Pyridines / adverse effects
  • Pyridines / therapeutic use
  • Pyridones / adverse effects
  • Pyridones / therapeutic use
  • Randomized Controlled Trials as Topic
  • Rivaroxaban / adverse effects
  • Rivaroxaban / therapeutic use
  • Stroke / prevention & control*
  • Thiazoles / adverse effects
  • Thiazoles / therapeutic use
  • Treatment Outcome
  • Warfarin / adverse effects
  • Warfarin / therapeutic use


  • Anticoagulants
  • Pyrazoles
  • Pyridines
  • Pyridones
  • Thiazoles
  • apixaban
  • Warfarin
  • Rivaroxaban
  • Dabigatran
  • edoxaban