Comparative safety and effectiveness of dabigatran vs. rivaroxaban and apixaban in patients with non-valvular atrial fibrillation: a retrospective study from a large healthcare system
| العنوان: | Comparative safety and effectiveness of dabigatran vs. rivaroxaban and apixaban in patients with non-valvular atrial fibrillation: a retrospective study from a large healthcare system |
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| المؤلفون: | Toni Rush, Eric Schwartzman, Wenbo Tang, Azhar Ahmad, Todd C. Villines, Kelly Oh, Michaela Petrini, David M. Thompson, Amber Evans |
| المصدر: | European Heart Journal — Cardiovascular Pharmacotherapy |
| بيانات النشر: | Oxford University Press (OUP), 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Male, Comparative Effectiveness Research, Time Factors, Databases, Factual, 030204 cardiovascular system & hematology, 0302 clinical medicine, Rivaroxaban, Risk Factors, Atrial Fibrillation, Apixaban, Pharmacology (medical), 030212 general & internal medicine, Stroke, Aged, 80 and over, Hazard ratio, Atrial fibrillation, Middle Aged, United States Department of Defense, Dabigatran, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, medicine.drug, Adult, medicine.medical_specialty, Adolescent, Pyridones, Hemorrhage, Lower risk, Antithrombins, Young Adult, 03 medical and health sciences, Propensity score matching, Internal medicine, medicine, Humans, Military Medicine, US Department of Defense Military Health System, Aged, Retrospective Studies, business.industry, Retrospective cohort study, Original Articles, medicine.disease, United States, Pyrazoles, business, Factor Xa Inhibitors |
| الوصف: | Aims We used the US Department of Defense Military Health System database to compare the safety and effectiveness of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) initiating dabigatran vs. rivaroxaban or apixaban. Methods and results Two cohorts of adults with NVAF, newly initiated on standard-dose DOAC, were identified based on clinical approval dates: July 2011–June 2016 for dabigatran (150 mg b.i.d.) or rivaroxaban (20 mg QD) and January 2013–June 2016 for dabigatran (150 mg b.i.d.) or apixaban (5 mg b.i.d.). Propensity score matching (1:1) identified two well-balanced cohorts (dabigatran vs. rivaroxaban n = 12 763 per treatment group; dabigatran vs. apixaban n = 4802 per treatment group). In both cohorts, baseline characteristics and follow-up duration were similar between treatment groups. Patients newly initiating dabigatran had significantly lower risk of major bleeding vs. rivaroxaban [2.08% vs. 2.53%; hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.70–0.97; P = 0.018], while stroke risk was similar (0.60% vs. 0.78%; HR 0.77, 95% CI 0.57–1.04; P = 0.084). The dabigatran vs. apixaban cohort analysis found no differences in risk of major bleeding (1.60% vs. 1.21%; HR 1.37, 95% CI 0.97–1.94; P = 0.070) or stroke (0.44% vs. 0.35%; HR 1.26, 95% CI 0.66–2.39; P = 0.489). Conclusion Among NVAF patients newly initiated on standard-dose DOAC therapy in this study, dabigatran was associated with significantly lower major bleeding risk vs. rivaroxaban, and no significant difference in stroke risk. For dabigatran vs. apixaban, the reduced sample size limited the ability to draw definitive conclusions. |
| تدمد: | 2055-6845 2055-6837 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::db0366f0bfba71fd71f81ad0f45946f8 https://doi.org/10.1093/ehjcvp/pvy044 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....db0366f0bfba71fd71f81ad0f45946f8 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20556845 20556837 |
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