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Comparative effectiveness of oral anticoagulants in everyday practice.
| Content Provider | Europe PMC |
|---|---|
| Author | Camm, A John Fox, Keith A A Virdone, Saverio Bassand, Jean-Pierre Fitzmaurice, David A Berchuck, Samuel I Gersh, Bernard J Goldhaber, Samuel Z Goto, Shinya Haas, Sylvia Misselwitz, Frank Pieper, Karen S Turpie, Alexander G G Verheugt, Freek W A Cappato, Riccardo Kakkar, Ajay K the GARFIELD-AF investigators |
| Copyright Year | 2021 |
| Abstract | ObjectivesThis study evaluated the comparative effectiveness of vitamin K antagonists (VKAs), direct thrombin inhibitors (DTIs) and factor Xa inhibitors (FXaI) in patients with atrial fibrillation (AF) at risk of stroke in everyday practice.MethodsData from patients with AF and Congestive heart failure, Hypertension, Age 75 years, Diabetes mellitus, prior Stroke, TIA, or thromboembolism, Vascular disease, Age 65-74 years, Sex category (CHA2DS2-VASc) score ≥2 (excluding gender) in the Global Anticoagulant Registry in the FIELD–Atrial Fibrillation registry were analysed using an improved method of propensity weighting, overlap weights and Cox proportional hazards models.ResultsAll-cause mortality, non-haemorrhagic stroke/systemic embolism (SE) and major bleeding over 2 years were compared in 25 551 patients, 7162 (28.0%) not treated with oral anticoagulant (OAC) and 18 389 (72.0%) treated with OAC (FXaI (41.8%), DTI (11.4%) and VKA (46.8%)). OAC treatment compared with no OAC treatment was associated with decreased risk of all-cause mortality (HR 0.82 (95% CI 0.74 to 0.91)) and non-haemorrhagic stroke/SE (HR 0.71 (95% CI 0.57 to 0.88)) but increased risk of major bleeding (HR 1.46 (95% CI 1.15 to 1.86)). Non-vitamin K antagonist oral anticoagulant (NOAC) use compared with no OAC treatment was associated with lower risks of all-cause mortality and non-haemorrhagic stroke/SE (HR 0.67 (95% CI 0.59 to 0.77)) and 0.65 (95% CI 0.50 to 0.86)) respectively, with no increase in major bleeding (HR 1.10 (95% CI 0.82 to 1.47)). NOAC use compared with VKA use was associated with lower risk of all-cause mortality and major bleeding (rates/100 patient-years 3.6 (95% CI 3.3 to 3.9) vs 4.8 (95% CI 4.5 to 5.2) and 1.0 (95% CI 0.9 to 1.1) vs 1.4 (95% CI 1.2 to 1.6); HR 0.79 (95% CI 0.70 to 0.89) and 0.77 (95% CI 0.61 to 0.98) respectively), with similar risk of non-haemorrhagic stroke/SE (rates/100 patient-years 0.8 (95% CI 0.7 to 0.9) versus 1.0 (95% CI 0.8 to 1.1); HR 0.96 (95% CI 0.73 to 1.25).ConclusionImportant benefits in terms of mortality and major bleeding were observed with NOAC versus VKA with no difference among NOAC subtypes.Trial registration numberNCT01090362. |
| Related Links | https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC8165153&blobtype=pdf |
| ISSN | 13556037 |
| Journal | Heart |
| Volume Number | 107 |
| DOI | 10.1136/heartjnl-2020-318420 |
| PubMed Central reference number | PMC8165153 |
| Issue Number | 12 |
| PubMed reference number | 33593994 |
| e-ISSN | 1468201X |
| Language | English |
| Publisher | BMJ Publishing Group |
| Publisher Date | 2021-05-26 |
| Publisher Place | BMA House, Tavistock Square, London, WC1H 9JR |
| Access Restriction | Open |
| Rights License | This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. |
| Subject Keyword | anticoagulation atrial fibrillation non-vitamin K oral antagonist vitamin K antagonist stroke |
| Content Type | Text |
| Resource Type | Article |
| Subject | Cardiology and Cardiovascular Medicine |
