Comparative Safety and Effectiveness of Oral Anticoagulants in Nonvalvular Atrial Fibrillation

التفاصيل البيبلوغرافية
العنوان: Comparative Safety and Effectiveness of Oral Anticoagulants in Nonvalvular Atrial Fibrillation
المؤلفون: Ph. Gabriel Steg, S. Gollety, François-Emery Cotté, Bruno Falissard, Eric Van Ganse, Nicolas Danchin, Maeva Nolin, F. Jacoud, Olivier Hanon, F. Dalon, Isabelle Mahé, Manon Belhassen, Cinira Lefevre
المصدر: Stroke
بيانات النشر: Ovid Technologies (Wolters Kluwer Health), 2020.
سنة النشر: 2020
مصطلحات موضوعية: safety, Adult, Male, medicine.medical_specialty, medicine.drug_class, Original Contributions, Embolism, Comparative safety, 030204 cardiovascular system & hematology, Clinical and Population Sciences, 03 medical and health sciences, 0302 clinical medicine, Rivaroxaban, Atrial Fibrillation, Humans, Medicine, 030212 general & internal medicine, Intensive care medicine, Aged, Advanced and Specialized Nursing, business.industry, anticoagulant, Anticoagulant, Anticoagulants, Atrial fibrillation, Middle Aged, medicine.disease, mortality, Dabigatran, Stroke, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Female, Apixaban, Warfarin, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Factor Xa Inhibitors, medicine.drug
الوصف: Supplemental Digital Content is available in the text.
Background and Purpose: The effects of direct oral anticoagulants in nonvalvular atrial fibrillation should be assessed in actual conditions of use. France has near-universal healthcare coverage with a unified healthcare information system, allowing large population-based analyses. NAXOS (Evaluation of Apixaban in Stroke and Systemic Embolism Prevention in Patients With Nonvalvular Atrial Fibrillation) aimed to compare the safety, effectiveness, and mortality of apixaban with vitamin K antagonists (VKAs), rivaroxaban, and dabigatran, in oral anticoagulant-naive patients with nonvalvular atrial fibrillation. Methods: This was an observational study using French National Health System claims data and including all adults with nonvalvular atrial fibrillation who initiated oral anticoagulant between 2014 and 2016. Outcomes of interest were major bleeding events leading to hospitalization (safety), stroke and systemic thromboembolic events (effectiveness), and all-cause mortality. Four approaches were used for comparative analyses: matching on propensity score (PS; 1:n); as a sensitivity analysis, matching on high-dimensional PS; adjustment on PS; and adjustment on known confounders. For each outcome, cumulative incidence rates accounting for competing risks of death were estimated. Results: Overall, 321 501 patients were analyzed, of whom 35.0%, 27.2%, 31.1%, and 6.6% initiated VKAs, apixaban, rivaroxaban, and dabigatran, respectively. Apixaban was associated with a lower PS–matched risk of major bleeding compared with VKAs (hazard ratio [HR], 0.43 [95% CI, 0.40–0.46]) and rivaroxaban (HR, 0.67 [95% CI, 0.63–0.72]), but not dabigatran (HR, 0.93 [95% CI, 0.81–1.08]). Apixaban was associated with a lower risk of stroke and systemic thromboembolic event compared with VKAs (HR, 0.60 [95% CI, 0.56–0.65]), but not rivaroxaban (HR, 1.05 [95% CI, 0.97–1.15]) or dabigatran (HR, 0.93 [95% CI, 0.78–1.11]). All-cause mortality was lower with apixaban than with VKAs, but not lower than with rivaroxaban or dabigatran. Conclusions: Apixaban was associated with superior safety, effectiveness, and lower mortality than VKAs; with superior safety than rivaroxaban and similar safety to dabigatran; and with similar effectiveness when compared with rivaroxaban or dabigatran. These observational data suggest potentially important differences in outcomes between direct oral anticoagulants, which should be explored in randomized trials.
تدمد: 1524-4628
0039-2499
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e66c764eb36ece7bc94082da22fc9f5d
https://doi.org/10.1161/strokeaha.120.028825
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....e66c764eb36ece7bc94082da22fc9f5d
قاعدة البيانات: OpenAIRE