Effectiveness and safety in non-valvular atrial fibrillation patients switching from warfarin to direct oral anticoagulants in US healthcare claims.
J Thromb Thrombolysis
; 57(6): 1092-1102, 2024 Aug.
Article
em En
| MEDLINE
| ID: mdl-38698197
ABSTRACT
INTRODUCTION:
There is a paucity of real-world studies examining the risks of stroke/systemic embolism (SE) and major bleeding (MB) among non-valvular atrial fibrillation (NVAF) patients switching from warfarin to a direct oral anticoagulant (DOAC). This retrospective study was conducted to compare the stroke/SE and MB risks between patients switched from warfarin to apixaban, dabigatran, or rivaroxaban in real-world clinical practice. MATERIALS ANDMETHODS:
This study used data from four United States commercial claims databases from January 1, 2012 to June 30, 2019. The study population included NVAF patients initially treated with warfarin and switched to apixaban, dabigatran, or rivaroxaban within 90 days of their warfarin prescription ending. Patients were matched 11 between the DOACs in each database using propensity scores and then pooled for the final analysis. Cox proportional hazards models were used to calculate the risk of stroke/SE and MB. RESULTS ANDCONCLUSIONS:
The final population consisted of 2,611 apixaban-dabigatran, 12,165 apixaban-rivaroxaban, and 2,672 dabigatran-rivaroxaban pairs. Apixaban vs. dabigatran was associated with a lower risk of stroke/SE (hazard ratio [HR] 0.61; 95% confidence interval [CI] 0.39-0.96) and MB (HR 0.67; 95% CI 0.50-0.91). Apixaban vs. rivaroxaban was associated with a similar risk of stroke/SE (HR 0.88; 95% CI 0.73-1.07) and a lower risk of MB (HR 0.60; 95% CI 0.52-0.68). There was no significant difference in either risk between dabigatran and rivaroxaban. These results provide important insights into how the risks of stroke/SE and MB for NVAF patients vary when switching from warfarin to different DOACs.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Pirazóis
/
Piridonas
/
Fibrilação Atrial
/
Varfarina
/
Acidente Vascular Cerebral
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Rivaroxabana
/
Dabigatrana
/
Hemorragia
/
Anticoagulantes
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article