Direct Xa inhibitors in addition to antiplatelet therapy in acute coronary syndrome: Meta-analysis of randomized trials

Pedro A. Villablanca, David Holmes, Divyanshu Mohananey, David F. Briceno, Ivan J. Núñez Gil, Faraj Kargoli, Tanush Gupta, Jorge R. Kizer, Anna E. Bortnick, Jose Wiley, Mark A. Menegus, Robert Pyo, Mario Garciá, Harish Ramakrishna, Farouk Mookadam

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective We carried out a meta-analysis summarizing the efficacy and safety of direct factor Xa inhibitor (DXI) in patients receiving guideline-based antiplatelet therapy (GBAT) after an acute coronary syndrome. Background Randomized-controlled trials have shown that the addition of a DXI to GBAT after acute coronary syndrome can reduce ischemic events, the trade-off being an increase in major bleeding complications. Methods PubMed, Central, Embase, The Cochrane Register, Google Scholar databases, and the scientific session abstracts were searched for eligible randomized trials from 1 January 1990 through 31 December 2016. Results Nine randomized-controlled trials were included in this meta-analysis enrolling a total of 45651 patients. There was a significant reduction in major adverse cardiovascular events with DXIs/GBAT compared with GBAT alone [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.82-0.94, number needed to treat=52]. There were also significant reductions in two individual components of major adverse cardiovascular events: Myocardial infarction (OR: 0.89; 95% CI: 0.81-0.98) and stent thrombosis (OR: 0.73; 95% CI: 0.59-0.90), favoring the DXI/GBAT group. There was an increased risk of major bleeding (OR: 2.51; 95% CI: 1.82-3.46) and intracranial hemorrhage (OR: 3.47; 95% CI: 1.76-6.86) compared with GBAT. Conclusion In acute coronary syndromes, the addition of a DXI to GBAT results in a significant reduction of major adverse cardiovascular events, myocardial infarction, and stent thrombosis, offset by an increased risk of bleeding.

Original languageEnglish (US)
Pages (from-to)395-405
Number of pages11
JournalCoronary Artery Disease
Issue number5
StatePublished - 2017


  • Acute coronary syndrome
  • direct Xa inhibitors
  • meta-analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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