LOGOMeta-Analysis of Randomized Controlled Trials on Risk ofMyocardial Infarction from the Use of Oral Direct ThrombinInhibitorsMeta-Analysis of Randomized Controlled Trials on Risk ofMyocardial Infarction from the Use of Oral Direct ThrombinInhibitorsBenni Andica Surya1st Journal ReadingIntroduction!theme"allery!comIntroduction!theme"allery!comIntroduction!theme"allery!comM#T$OD%This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines To address the observation of incidence of MI in trials with oral DTIs we searched M!D"I#! !mbase and the $ochrane $ollaboration up to March %&'( using )ey words* +oral, +direct thrombin inhibitor, with the limiting term +clinical trial, without language or publication date restrictions- !theme"allery!com!theme"allery!comR#%ULT!theme"allery!comRESULT: Participants!theme"allery!comRESULT: outcome observation .verall the entire cohort of oral DTIs was associated with a significantly higher rate of MI compared with warfarin- MI was reported in %/0 of %(((( sub1ects treated with oral DTIs versus '(( of '2&%3 sub1ects treated with warfarin with an .R of '-(0 4506 $I '-'& to '-227 p 8 &-&&0!theme"allery!comCom&any Lo"o!theme"allery!comRESULT :Bias risk assessment!theme"allery!comRESULT : All Cause mortality!theme"allery!com.verall sub1ects treated with warfarin had similar rate of MI than those treated with comparator agents- There were 3&( out of ('/29 sub1ects treated with warfarin compared with 0&( out of (993/ sub1ects treated with comparator agents 4.R '-&2 506 $I &-/0 to '-(3 p 8 &-057!theme"allery!comCom&any Lo"oISCUSSI!"In the present meta-analysis we have demonstrated that oral DTIs as a group were associated with an increased ris) of MI compared with warfarin among (5(09 patients analy:ed-The second meta-analysis on 252'0 sub1ects showed no significant difference in the rates of MI among those treated with warfarin versus those in the combined cohort of aspirin alone aspirin plus clopidogrel factor ;a inhibitors-!theme"allery!comCom&any Lo"oThe relative ris) of MI for a patient treated with dabigatran for any indication compared with warfarin is 3'6 and the absolute ris) difference remains small at &-0(6- The number needed to treat to cause ' MI compared with warfarin is '//-In a meta-analysis on contemporary atrial fibrillation stro)e prevention trials by "ip et al0 from %&'& the investigators hypothesi:ed that warfarin might have a protective effect against MI compared with non-warfarin anticoagulants-!theme"allery!comCom&any Lo"o#$y %!vidently there are % different classes of the DTIs* the bivalent including hirudin and bivalirudin and univalent including argatroban