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Effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in atrial fibrillation: a Scandinavian population-based cohort study
| Content Provider | Oxford Academic |
|---|---|
| Author | Halvorsen, Sigrun Johnsen, Søren P Madsen, Morten Linder, Marie Sulo, Gerhard Ghanima, Waleed Gislason, Gunnar Hohnloser, Stefan H Jenkins, Aaron Al-Khalili, Faris Tell, Grethe S Ehrenstein, Vera |
| Copyright Year | 2022 |
| Abstract | Aim: Using Scandinavian population-based registries, we assessed risk of stroke/systemic embolism (SE) and bleeding with non-vitamin K antagonist oral anticoagulants compared with warfarin in anticoagulation-naïve patients with atrial fibrillation (AF).Methods and resultsThis historical cohort study included 219 545 AF patients [median age 74 years; 43% women; mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischaemic attack, vascular disease, age 65–74 years, sex category) score 3.3] initiating apixaban, dabigatran, rivaroxaban, or warfarin in Denmark, Norway, and Sweden (1 January 2013 to 31 December 2016). The primary endpoints were stroke/SE and major bleeding. The median follow-up times were 9.7 (3.9–21.5) months for stroke/SE and 9.6 (3.8–21.3) months for bleeding. Apixaban and warfarin initiators were older and had higher CHA2DS2-VASc scores compared with dabigatran and rivaroxaban initiators. After 1:1 propensity score matching, three cohorts were created: apixaban–warfarin (n = 111 162), dabigatran–warfarin (n = 56 856), and rivaroxaban–warfarin (n = 61 198). Adjusted hazard ratios (HRs) were estimated using a Cox regression. For stroke/SE, adjusted HRs against warfarin were 0.96 [95% confidence interval (CI): 0.87–1.06] for apixaban, 0.89 (95% CI: 0.80–1.00) for dabigatran, and 1.03 (95% CI: 0.92–1.14) for rivaroxaban. For major bleeding, the HRs against warfarin were 0.73 (95% CI: 0.67–0.78) for apixaban, 0.89 (95% CI: 0.82–0.97) for dabigatran, and 1.15 (95% CI: 1.07–1.25) for rivaroxaban. The results in the dabigatran cohort did not hold in all dose-defined subgroups.ConclusionIn this large Scandinavian study among AF patients initiating oral anticoagulation, those initiating dabigatran, apixaban, and rivaroxaban had similar rates of stroke/SE to patients initiating warfarin. Rates of major bleeding were lower with apixaban and dabigatran and higher with rivaroxaban, each compared with warfarin. |
| Related Links | https://academic.oup.com/ehjqcco/article-pdf/8/5/577/45450228/qcab048.pdf |
| Ending Page | 587 |
| Starting Page | 577 |
| File Format | |
| ISSN | 20585225 |
| e-ISSN | 20581742 |
| DOI | 10.1093/ehjqcco/qcab048 |
| Journal | European Heart Journal - Quality of Care and Clinical Outcomes |
| Issue Number | 5 |
| Volume Number | 8 |
| Language | English |
| Publisher | Oxford Academic |
| Publisher Date | 2022-08-17 |
| Access Restriction | Open |
| Subject Keyword | Cardiovascular Medicine Clinical Medicine Medicine and Health Anticoagulants Atrial Fibrillation Bleeding Cohort Study Stroke |
| Content Type | Text |
| Resource Type | Article |
| Subject | Health Policy Cardiology and Cardiovascular Medicine |
