Comparative effectiveness of rivaroxaban versus warfarin or dabigatran for the treatment of patients with non-valvular atrial fibrillation

BMC Cardiovascular Disorders

Research Article

Lin Y. Chen¹  Alvaro Alonso²  Alanna M. Chamberlain³  Ian Rapson⁴  Richard F. MacLehose⁴  Pamela L. Lutsey⁴  Faye L. Norby⁴  Lindsay G.S. Bengtson⁵ 

[1] Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA;Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA;Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd St, Suite 300, 55454, Minneapolis, MN, USA;Health Economics and Outcomes Research, Life Sciences, Optum, Eden Prairie, MN, USA;

关键词: Non-valvular atrial fibrillation;    Stroke;    Warfarin;    Dabigatran;    Rivaroxaban;   

DOI  :  10.1186/s12872-017-0672-5

 received in 2016-11-30, accepted in 2017-08-24,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundRivaroxaban is an oral anticoagulant approved in the US for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). We determined the effectiveness and associated risks of rivaroxaban versus other oral anticoagulants in a large real-world population.MethodsWe selected NVAF patients initiating oral anticoagulant use in 2010–2014 enrolled in MarketScan databases. Rivaroxaban users were matched with warfarin and dabigatran users by age, sex, enrolment date, anticoagulant initiation date, and high-dimensional propensity score. Study endpoints, including ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding, were identified from inpatient diagnostic codes. Multivariable Cox models were used to assess associations between type of anticoagulant and outcomes.ResultsThe analysis included 44,340 rivaroxaban users matched to 89,400 warfarin and 16,957 dabigatran users (38% female, mean age 70) with 12 months of mean follow-up. Anticoagulant-naïve rivaroxaban initiators, but not those switching from warfarin, had lower risk of ischemic stroke [hazard ratio (HR) (95% confidence interval (CI)): 0.75 (0.62, 0.91)] and ICB [HR (95%CI): 0.55, (0.39, 0.78)] than warfarin users. In contrast, anticoagulant-experienced rivaroxaban initiators had higher risk of GI bleeding than warfarin users [HR (95%CI): 1.55 (1.32, 1.83)]. Endpoint rates were similar when comparing anticoagulant-naïve rivaroxaban and dabigatran initiators, with the exception of higher GI bleeding risk in rivaroxaban users [HR (95%CI) 1.28 (1.06, 1.54)]. There were no significant differences in the risk of MI among the comparison groups.ConclusionIn this large real-world sample of NVAF patients, effectiveness and risks of rivaroxaban versus warfarin differed by prior anticoagulant status, while effectiveness of rivaroxaban versus dabigatran differed in GI bleeding risk.

【 授权许可】

CC BY   
© The Author(s). 2017