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lüll Comparative effectiveness of dabigatran, rivaroxaban, apixaban, and warfarin in the management of patients with nonvalvular atrial fibrillation Pink J; Pirmohamed M; Hughes DAClin Pharmacol Ther 2013[Aug]; 94 (2): 269-76Alternative anticoagulants to warfarin (dabigatran, rivaroxaban, and apixaban) are becoming available for the prevention of thromboembolic stroke in atrial fibrillation (AF), but there is a lack of information on their comparative effectiveness. Using a discrete event simulation method adopting a lifetime horizon of analysis, we made an indirect comparison of the RE-LY, ROCKET-AF, and ARISTOTLE trial results for AF patients in the US population. Over a lifetime, apixaban, dabigatran, and rivaroxaban accrued 0.130 (95% central range (CR) -0.030 to 0.264), 0.106 (95% CR -0.048 to 0.248), and 0.095 (95% CR -0.052 to 0.242) more quality-adjusted life-years (QALYs), respectively, than warfarin, with apixaban having a 55% probability of accruing the highest total QALYs. In the absence of a definitive trial, and acknowledging the limitations of an indirect comparison, the available evidence suggests apixaban to be the most effective anticoagulant.|*Computer Simulation[MESH]|Age Factors[MESH]|Aged[MESH]|Antithrombins/administration & dosage/adverse effects/*therapeutic use[MESH]|Atrial Fibrillation/*drug therapy[MESH]|Benzimidazoles/therapeutic use[MESH]|Cardiovascular Diseases/epidemiology[MESH]|Comorbidity[MESH]|Dabigatran[MESH]|Female[MESH]|Hemorrhage/chemically induced[MESH]|Humans[MESH]|Male[MESH]|Morpholines/therapeutic use[MESH]|Pyrazoles/therapeutic use[MESH]|Pyridones/therapeutic use[MESH]|Quality-Adjusted Life Years[MESH]|Randomized Controlled Trials as Topic[MESH]|Rivaroxaban[MESH]|Thiophenes/therapeutic use[MESH]|Time Factors[MESH]|Warfarin/therapeutic use[MESH]|beta-Alanine/analogs & derivatives/therapeutic use[MESH] |