Comparative Safety and Effectiveness of Reduced Doses of Direct Acting Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation - 29/05/24
, Alexander Rieem Dun, MSc f, Mathias Lilja, MSc f, Iffat Rahman, MSc d, Khaled Abdelgawwad, MSc, MBA e, Sigrun Halvorsen, MD, PhD g, Craig Coleman, PharmD h, Marcela Rivera, MSc, PhD eABSTRACT |
Background |
This Nordic observational cohort study aims to assess the effectiveness and safety of reduced-dose direct-acting oral anticoagulants (DOACs) dabigatran, rivaroxaban, and apixaban compared to standard warfarin for stroke prevention in nonvalvular atrial fibrillation.
Methods |
The study, utilizing nationwide administrative databases from Denmark, Sweden, Norway, and Finland, spanned from January 1, 2011 to December 31, 2018 (2017 for Sweden). The cohort included 26,883 patients initiating reduced-dose DOACs and 108,014 comparable warfarin patients. Effectiveness was measured by the composite endpoint of ischemic stroke and systemic embolism, while safety was assessed through intracranial hemorrhage.
Results |
The meta-analysis across countries revealed similar or lower incidences of ischemic stroke and systemic embolism in patients on reduced-dose DOACs compared to standard warfarin (rivaroxaban: HR 0.93, dabigatran: HR 0.88, apixaban: HR 0.79). Incidences within warfarin groups ranged from 2.16 to 3.71 per 100 person-years, comparable to DOAC recipients. Intracranial hemorrhage rates were generally low, ranging from 0.16 to 1.85 per 100 person-years. In comparison with warfarin patients, meta-analyses yielded HRs for rivaroxaban (1.41), dabigatran (0.35), and apixaban (0.72).
Conclusions |
In this study, atrial fibrillation patients initiating reduced-dose rivaroxaban and dabigatran exhibited incidences of ischemic stroke and systemic embolism similar to warfarin, and for apixaban, even lower. Rates of intracranial hemorrhage were comparable to or lower for patients on DOACs compared to warfarin.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Cardiovascular, Cohort, Epidemiology, Oral anticoagulation
Plan
| Funding: Bayer AG partly funded this research by an unrestricted grant. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. |
|
| Declaration of competing interest: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: TBL has served as an investigator for Janssen Scientific Affairs, Bayer AG, LLC, and Boehringer Ingelheim and has served as a speaker for Bayer, Bristol-Myers Squibb/Pfizer, and Boehringer Ingelheim. ARD and ML are employees of Quantify Research, a contract research organization that provides consultancy services to the pharmaceutical industry. IR is employed by SDS Life Science—a Cytel company, a consultancy company that provides services to the pharmaceutical and biotech industry. KA is an employee of Bayer AG. SH has served as an investigator for Bayer, Bristol-Myers Squibb/Pfizer, and Boehringer Ingelheim and as a speaker for Bristol-Myers Squibb/Pfizer and Boehringer Ingelheim. CC has received grant funding from Janssen Scientific Affairs, LLC, Bayer AG and AstraZeneca Pharmaceuticals. MR was an employee of Bayer AG at the time of study conduct and is currently an employee of Johnson & Johnson Research and Development. FLS has nothing to declare. |
|
| Authorship: FLS and TBL had full access to all results of the study. FLS takes responsibility for the integrity of the Danish data and the accuracy of the Danish data analysis. FLS and TBL have written the first draft of the paper and TBL has updated and completed the final version based on input from the other authors. ARD and MJ take responsibility for the integrity of the data and the accuracy of the analysis representing Norway, Sweden, and Finland. They are the guarantors. All authors contributed to the design; analyzed and interpreted the data; drafted the article or revised it critically for important intellectual content; and approved the final version to be published. |
Vol 137 - N° 6
P. 520 - juin 2024 Retour au numéro
Article précédent
- Factors Associated With Long COVID: Insights From Two Nationwide Surveys
- Yixuan Wu, Mitsuaki Sawano, Yilun Wu, Rishi M. Shah, Pamela Bishop, Akiko Iwasaki, Harlan M. Krumholz
- Association of Obstructive Sleep Apnea with Post-Acute Sequelae of SARS-CoV-2 Infection
- Stuart F. Quan, Matthew D. Weaver, Mark É. Czeisler, Laura K. Barger, Lauren A. Booker, Mark E. Howard, Melinda L. Jackson, Rashon I. Lane, Christine F. McDonald, Anna Ridgers, Rebecca Robbins, Prerna Varma, Joshua F. Wiley, Shantha M.W. Rajaratnam, Charles A. Czeisler
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?