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Direct comparisons of effectiveness and safety of treatment with Apixaban, Dabigatran and Rivaroxaban in atrial fibrillation
Umea Univ, Dept Publ Hlth & Clin Med, Sundsvall, Sweden.
Umea Univ, Dept Publ Hlth & Clin Med, Sundsvall, Sweden.
Umea Univ, Dept Publ Hlth & Clin Med, Sundsvall, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.ORCID iD: 0000-0002-2141-6086
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2020 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 185, p. 135-141Article in journal (Refereed) Published
Abstract [en]

Introduction: Direct oral anticoagulants (DOACs) have been proven non-inferior or superior to warfarin in preventing stroke and systemic embolism, with a lower risk of major hemorrhage, in patients with non-valvular atrial fibrillation (NVAF). We sought to investigate whether effectiveness and safety differs among apixaban, rivaroxaban and dabigatran.

Materials and methods: Patients with newly initiated DOAC treatment were identified from the Swedish anticoagulation quality registry, ranging from January 1, 2013 to December 31, 2015. Patients were assigned to apixaban, dabigatran or rivaroxaban cohorts based on initiated DOAC and dose (standard or reduced). Baseline characteristics and endpoints were retrieved from validated Swedish quality registers and the National Patient Registry. Cohorts were matched using full optimal matching and directly compared.

Results: A total of 25,843 NVAF patients were included. Patients treated with standard dose apixaban or dabigatran had lower risk of major bleeding than patients treated with rivaroxaban, HR 0.69 (95% CI 0.54-0.88) and HR 0.64 (95% CI 0.48-0.87). Regarding reduced dose, patients treated with apixaban had lower risk of major bleeding than those treated with dabigatran or rivaroxaban, HR 0.62 (95% CI 0.44-0.88) and HR 0.45 (95% CI 0.33-0.61). In reduced dose, patients treated with dabigatran had the lowest all-cause mortality. No differences in effectiveness were found.

Conclusions: In this large real-world NVAF cohort, direct comparisons show a favorable bleeding risk profile for dabigatran and apixaban in standard dose, and for apixaban in reduced dose. No differences in effectiveness were found. This study confirms previous indirect DOAC comparisons. Further studies are needed.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD , 2020. Vol. 185, p. 135-141
Keywords [en]
Dabigatran, Rivaroxaban, Treatment outcome, Apixaban, Anticoagulants, Atrial fibrillation
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-403245DOI: 10.1016/j.thromres.2019.11.010ISI: 000506413800023PubMedID: 31816553OAI: oai:DiVA.org:uu-403245DiVA, id: diva2:1389010
Funder
Swedish Heart Lung Foundation, 20150435Available from: 2020-01-28 Created: 2020-01-28 Last updated: 2020-01-28Bibliographically approved

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Renlund, Henrik

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