Comparison of the Effectiveness and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Newly Diagnosed Atrial Fibrillation

No studies have performed direct pairwise comparisons of the effectiveness and safety of warfarin and the new oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban. Using 2013 to 2014 claims from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with at...

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Bibliographic Details
Published in:The American journal of cardiology 2017-11, Vol.120 (10), p.1813-1819
Main Authors: Hernandez, Inmaculada, Zhang, Yuting, Saba, Samir
Format: Article
Language:English
Subjects:
Administration, Oral
Aged
Anticoagulants
Anticoagulants - administration & dosage
Antithrombins - administration & dosage
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - drug therapy
Bleeding
Cardiac arrhythmia
Coagulation
Confidence intervals
Dabigatran - administration & dosage
Dose-Response Relationship, Drug
Embolism
Embolism - epidemiology
Embolism - prevention & control
Factor Xa Inhibitors - administration & dosage
Female
Fibrillation
Follow-Up Studies
Government programs
Health care
Humans
Incidence
Ischemia
Male
Pennsylvania - epidemiology
Pyrazoles - administration & dosage
Pyridones - administration & dosage
Retrospective Studies
Risk
Rivaroxaban - administration & dosage
Safety
Stroke
Stroke - epidemiology
Stroke - etiology
Stroke - prevention & control
Treatment Outcome
Warfarin
Warfarin - administration & dosage
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Summary:No studies have performed direct pairwise comparisons of the effectiveness and safety of warfarin and the new oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban. Using 2013 to 2014 claims from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with atrial fibrillation who initiated apixaban, dabigatran, rivaroxaban, warfarin, or no oral anticoagulation therapy in 2013 to 2014. Outcomes included the composite of ischemic stroke, systemic embolism (SE) and death, any bleeding event, gastrointestinal bleeding, intracranial bleeding, and treatment persistence. We constructed Cox proportional hazard models to compare outcomes between each pair of treatment groups. The composite risk of ischemic stroke, SE, and death was lower for NOACs than for warfarin: hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76 to 0.98 for apixaban; 0.73, 95% CI 0.63 to 0.86 for dabigatran; and 0.82, 95% CI 0.75 to 0.89 for rivaroxaban, all compared with warfarin. There were no differences in effectiveness across NOACs. The risk of any bleeding was lower with apixaban than with warfarin, but higher with rivaroxaban than with warfarin. Apixaban (HR 0.69, 95% CI 0.60 to 0.79) and dabigatran (HR 0.79, 95% CI 0.69 to 0.92) were associated with lower bleeding risk than rivaroxaban. Treatment persistence was highest for apixaban (82%), and lowest for dabigatran and warfarin (64%) (p value
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2017.07.092