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Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.

Methodology Score: 3.5/5       
Usefulness Score: 4/5 

Ruff CT, et al.
Lancet. 2014 Mar 15;383(9921):955-62.


This systematic review comparing NOACs to warfarin for patients with atrial fibrillation found that NOACs were marginally safer and more effective than warfarin.  JC attendees felt that the efficacy outcome may have been falsely inflated because hemorrhagic stroke was included in both the efficacy and safety outcomes, and they also had concerns that all 4 trials examined were funded by pharmaceutical companies.  Despite this, these results could be applied to ED patients requiring de novo anticoagulation for their new-onset atrial fibrillation, especially given the difficulties in starting a patient on warfarin from the ED.
By: Dr. Ashley Krywenky


Epi Lesson: PRISMA statement

The PRISMA statement was developed by an international group to establish preferred reporting guidelines for systematic reviews and meta-analyses. David Moher of the Ottawa Hospital Research Institute is the lead author on the paper (www.bmj.com/content/339/bmj.b2535.full) that includes the PRISMA 27-item checklist and four-phase flow diagram. 
By: Dr. Ian Stiell

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