{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T01:55:21Z","timestamp":1785894921457,"version":"3.56.0"},"reference-count":49,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur Cardiol"],"abstract":"<jats:p>Background: Direct oral anticoagulants (DOACs) are the standard treatment for stroke prevention in AF. However, high-quality head-to-head comparisons of DOACs are lacking. This study compared oral anticoagulants in patients with AF. Methods: Data were retrieved from eligible randomised controlled trials (RCTs). Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) and the frequentist random effects model was applied. Efficacy outcomes included stroke, systemic embolism, MI, and all-cause mortality; the safety outcome was major bleeding. A composite outcome of efficacy and net clinical benefit was also evaluated. Results: From 23,152 records, 11 eligible RCTs were identified and included in the study. Rivaroxaban was superior to vitamin K antagonists (VKA) in net clinical benefit (RR 0.75; 95% CI [0.59\u20130.94]; p=0.0133), but there were no significant differences between other DOACs and VKA or among the DOACs themselves. Rivaroxaban reduced the risk of the composite outcome of efficacy compared with dabigatran (RR 0.85; 95% CI [0.75\u20130.98]; p=0.02) and edoxaban (RR 0.84; 95% CI [0.75\u20130.95]; p=0.0051), but not apixaban (RR 0.89; 95% CI [0.89\u20131.02]; p=0.087). All DOACs showed superiority over VKA in efficacy, without an increased risk of major bleeding. Based on the SUCRA, rivaroxaban showed a favourable risk\u2013benefit profile compared with the other anticoagulants. Conclusion: This study showed that DOACs are superior to VKA in efficacy without increasing major bleeding risk, with rivaroxaban demonstrating the most balanced risk\u2013benefit profile. Well-designed RCTs are needed to validate these findings.<\/jats:p>","DOI":"10.15420\/ecr.2025.07","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T10:24:37Z","timestamp":1747045477000},"source":"Crossref","is-referenced-by-count":8,"title":["Comparative Analysis of the Net Clinical Benefit of Direct Oral Anticoagulants in Atrial Fibrillation: Systematic Review and Network Meta-analysis of Randomised Controlled Trials"],"prefix":"10.15420","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7210-3522","authenticated-orcid":false,"given":"Ton Duy","family":"Mai","sequence":"first","affiliation":[{"name":"Stroke Center, Bach Mai Hospital, Hanoi, Vietnam; Faculty of Stroke and Cerebrovascular Disease, VNU University of Medicine and Pharmacy, Hanoi, Vietnam; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5226-5372","authenticated-orcid":false,"given":"Tri Huynh Quang","family":"Ho","sequence":"additional","affiliation":[{"name":"Heart Institute, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3984-648X","authenticated-orcid":false,"given":"Sy Van","family":"Hoang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Cardiovascular Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-3061","authenticated-orcid":false,"given":"Hoai Thi Thu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, VNU University of Medicine and Pharmacy, Hanoi, Vietnam; Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0028-1968","authenticated-orcid":false,"given":"Jeyaraj","family":"Pandian","sequence":"additional","affiliation":[{"name":"Department of Neurology, Christian Medical College, Ludhiana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0234-6596","authenticated-orcid":false,"given":"Tan Van","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6350-8416","authenticated-orcid":false,"given":"Khoa Tien","family":"Vu","sequence":"additional","affiliation":[{"name":"Medical Affairs Department, Bayer Vietnam, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giang Song","family":"Tran","sequence":"additional","affiliation":[{"name":"Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viet Phuong","family":"Dao","sequence":"additional","affiliation":[{"name":"Stroke Center, Bach Mai Hospital, Hanoi, Vietnam; Faculty of Stroke and Cerebrovascular Disease, VNU University of Medicine and Pharmacy, Hanoi, Vietnam; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2622-1365","authenticated-orcid":false,"given":"Minh Cong","family":"Tran","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8943-3248","authenticated-orcid":false,"given":"Hung Manh","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ha Noi Medical University, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2025,5,9]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Montinari MR, Minelli S, De Caterina R. 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Eur Cardiol 2023;19:e01. https:\/\/doi.org\/10.15420\/ecr.2023.40; PMID: 38708371.","DOI":"10.15420\/ecr.2023.40"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Ezekowitz MD, Reilly PA, Nehmiz G, et al. Dabigatran with or without concomitant aspirin compared with warfarin alone in patients with nonvalvular atrial fibrillation (PETRO study). Am J Cardiol 2007;100:1419\u201326. https:\/\/doi.org\/10.1016\/j.amjcard.2007.06.034; PMID: 17950801.","DOI":"10.1016\/j.amjcard.2007.06.034"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Waranugraha Y, Rizal A, Syaban MFR, et al. Direct comparison of non-vitamin K antagonist oral anticoagulant versus warfarin for stroke prevention in non-valvular atrial fibrillation: a systematic review and meta-analysis of real-world evidences. Egypt Heart J 2021;73:70. https:\/\/doi.org\/10.1186\/s43044-021-00194-1; PMID: 34379219.","DOI":"10.1186\/s43044-021-00194-1"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"G\u00f3mez-Outes A, Su\u00e1rez-Gea ML, Garc\u00eda-Pinilla JM. Causes of death in atrial fibrillation: challenges and opportunities. Trends Cardiovasc Med 2017;27:494\u2013503. https:\/\/doi.org\/10.1016\/j.tcm.2017.05.002; PMID: 28602539.","DOI":"10.1016\/j.tcm.2017.05.002"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Lau WCY, Torre CO, Man KKC, et al. Comparative effectiveness and safety between apixaban, dabigatran, edoxaban, and rivaroxaban among patients with atrial fibrillation: a multinational population-based cohort study. Ann Intern Med 2022;175:1515\u201324. https:\/\/doi.org\/10.7326\/M22-0511; PMID: 36315950.","DOI":"10.7326\/m22-0511"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Deitelzweig S, Keshishian A, Li X, et al. Comparisons between oral anticoagulants among older nonvalvular atrial fibrillation patients. J Am Geriatr Soc 2019;67:1662\u201371. https:\/\/doi.org\/10.1111\/jgs.15956; PMID: 31112292.","DOI":"10.1111\/jgs.15956"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Dhamane AD, Ferri M, Keshishian A, et al. Effectiveness and safety of direct oral anticoagulants among patients with non-valvular atrial fibrillation and multimorbidity. Adv Ther 2023;40:887\u2013902. https:\/\/doi.org\/10.1007\/s12325-022-02387-9; PMID: 36527598.","DOI":"10.1007\/s12325-022-02387-9"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Jaksa A, Gibbs L, Kent S, et al. Using primary care data to assess comparative effectiveness and safety of apixaban and rivaroxaban in patients with nonvalvular atrial fibrillation in the UK: an observational cohort study. 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