Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and the intervention is more effective/beneficial than the comparison for key outcomes.
Population: Adults with AF deemed eligible for long‐term anticoagulant treatment ᵃ
Intervention: Factor Xa inhibitor (e.g., apixaban, rivaroxaban, edoxaban, betrixaban)
Comparison: Dose-adjusted warfarin
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Systemic embolic events including stroke (12 weeks to 2.8 years) | Favors intervention | High |
Systemic embolic events excluding stroke (12 weeks to 2.8 years) | Favors intervention | GRADE assessment not performed for this outcome |
Any stroke (12 weeks to 2.8 years) | Favors intervention | High |
Ischemic stroke (12 weeks to 2.8 years) | No statistically significant difference | GRADE assessment not performed for this outcome |
Disabling or fatal stroke (timing of outcome unclear) ᵇ | No statistically significant difference | GRADE assessment not performed for this outcome |
Myocardial infarction (timing of outcome unclear) | No statistically significant difference | GRADE assessment not performed for this outcome |
Vascular mortality (timing of outcome unclear) | Favors intervention | GRADE assessment not performed for this outcome |
All‐cause mortality (12 weeks to 2.8 years) | Favors intervention | Moderate |
Major bleeding (12 weeks to 2.8 years) ᶜ | Favors intervention ᵈ | Moderate |
Intracranial hemorrhage (12 weeks to 2.8 years) | Favors intervention | High |
Nonmajor clinically relevant bleed (12 weeks to 2.8 years) | No statistically significant difference | GRADE assessment not performed for this outcome |
Quality of life, participant satisfaction | - | The reviewers did not assess these outcomes |
Nonbleeding adverse events | - | Data was too sparse to analyze |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) advises caution when interpreting the net clinical benefit of factor Xa Inhibitors for people with a very low risk of thromboembolic events, severe renal impairment, or those on hemodialysis, as in general they were excluded from the analyzed studies. ᵃ The CCA notes that most of the participants within the studies were men between the ages of 65 and 74 years of age with an unknown duration of AF, resulting in some uncertainty over the generalizability of these results. ᵇ The CCA also notes that different definitions of disabling stroke were used in included studies which might affect the interpretation/relevance of this outcome. ᶜ A subgroup analysis of people receiving idraparinux (currently in development) resulted in more major bleeds, intracranial hemorrhage, or nonmajor clinically relevant bleeds in this group than in people receiving dose-adjusted warfarin. However, the Cochrane review which underpins this CCA notes that the majority of the included data was for apixaban (18,358 participants), edoxaban (22,922 participants), and rivaroxaban (15,514 participants). ᵈ The Cochrane review reports high heterogeneity for major bleeding when using a fixed-effects model; due to this high heterogeneity an analysis using a random-effects model was also carried out which did not show a statistically significant difference between treatment groups.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How do factor Xa inhibitors compare with warfarin for prevention of cerebral and systemic embolism in people with atrial fibrillation (AF)?
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