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Editor's Correspondence
May 13, 2013

New Oral Anticoagulants in Acute Coronary Syndromes: What Does a Meta-analysis Tell Us?—Reply

Author Affiliations

Author Affiliations: Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary.

JAMA Intern Med. 2013;173(9):835-836. doi:10.1001/jamainternmed.2013.424

In reply

We greatly appreciate the interest of Kwong et al in our article that analyzed the risks and benefits of new-generation oral anticoagulants in patients with acute coronary syndromes.1

In their letter, Kwong and colleagues raise some criticism regarding the selection of the included trials. It should be admitted that the “Safety and Efficacy of TAK-442 in Subjects With Acute Coronary Syndromes” (AXIOM-ACS) phase 2 trial was not identified by our literature search strategy and was not included in our analysis. It should be highlighted that despite the study termination in June 2010, clinical results are still unpublished.2 However, when results of the published congress abstract were added to our meta-analysis, the overall findings were unchanged, with odds ratios of 2.72 (95% CI, 1.87-3.35) and 2.63 (95% CI, 2.18-3.16) regarding Thrombolysis in Myocardial Infarction (TIMI) major bleeding and major or clinically significant nonmajor bleeding, respectively, and an odds ratio of 0.86 (95% CI, 0.79-0.94) regarding the composite ischemic end point (P < .001 for each), which is consistent with our prior analysis.