Christina Ji-Young Lee1, Thomas Alexander Gerds2, Nicholas Carlson3, Anders Nissen Bonde4, Gunnar Hilmar Gislason5, Morten Lamberts6, Jonas Bjerring Olesen4, Jannik Langtved Pallisgaard4, Morten Lock Hansen4, Christian Torp-Pedersen7. 1. Department of Health Science and Technology, Aalborg University and Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark. Electronic address: cjilee@outlook.com. 2. Department of Biostatistics, Copenhagen University, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark. 3. Department of Internal Medicine, Holbaek Hospital, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark. 4. Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark. 5. Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark. 6. The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 7. Department of Health Science and Technology, Aalborg University and Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
Abstract
BACKGROUND: Evidence is conflicting as to the efficacy of direct oral anticoagulation (DOAC) and vitamin K antagonist (VKA) for prevention of myocardial infarction (MI). OBJECTIVES: This study aimed to investigate the risk of MI associated with the use of apixaban, dabigatran, rivaroxaban, and VKA in patients with atrial fibrillation. METHODS: Patients with atrial fibrillation were identified using Danish health care registers and stratified by initial oral anticoagulant treatment. Standardized absolute 1-year risks were estimated based on Cox regression for hazard rates of MI hospitalizations and mortality. Reported were absolute risks separately for the oral anticoagulation treatments and standardized to the characteristics of the study population. RESULTS: Of the 31,739 patients included (median age, 74 years; 47% females), the standardized 1-year risk of MI for VKA was 1.6% (95% confidence interval [CI]: 1.3 to 1.8), apixaban was 1.2% (95% CI: 0.9 to 1.4), dabigatran was 1.2% (95% CI: 1.0 to 1.5), and rivaroxaban was 1.1% (95% CI: 0.8 to 1.3). No significant risk differences were observed in the standardized 1-year risks of MI among the DOACs: dabigatran versus apixaban (0.04%; 95% CI: -0.3 to 0.4), rivaroxaban versus apixaban (0.1%; 95% CI: -0.4 to 0.3), and rivaroxaban versus dabigatran (-0.1%; 95% CI: -0.5 to 0.2). The risk differences for DOACs versus VKA were all significant: -0.4% (95% CI: -0.7 to -0.1) for apixaban, -0.4% (95% CI: -0.7 to -0.03) for dabigatran, and -0.5% (95% CI: -0.8 to -0.2) for rivaroxaban. CONCLUSIONS: No significant risk differences of MI were found in the direct comparisons of DOACs, and DOACs were all associated with a significant risk reduction of MI compared with VKA.
BACKGROUND: Evidence is conflicting as to the efficacy of direct oral anticoagulation (DOAC) and vitamin K antagonist (VKA) for prevention of myocardial infarction (MI). OBJECTIVES: This study aimed to investigate the risk of MI associated with the use of apixaban, dabigatran, rivaroxaban, and VKA in patients with atrial fibrillation. METHODS:Patients with atrial fibrillation were identified using Danish health care registers and stratified by initial oral anticoagulant treatment. Standardized absolute 1-year risks were estimated based on Cox regression for hazard rates of MI hospitalizations and mortality. Reported were absolute risks separately for the oral anticoagulation treatments and standardized to the characteristics of the study population. RESULTS: Of the 31,739 patients included (median age, 74 years; 47% females), the standardized 1-year risk of MI for VKA was 1.6% (95% confidence interval [CI]: 1.3 to 1.8), apixaban was 1.2% (95% CI: 0.9 to 1.4), dabigatran was 1.2% (95% CI: 1.0 to 1.5), and rivaroxaban was 1.1% (95% CI: 0.8 to 1.3). No significant risk differences were observed in the standardized 1-year risks of MI among the DOACs: dabigatran versus apixaban (0.04%; 95% CI: -0.3 to 0.4), rivaroxaban versus apixaban (0.1%; 95% CI: -0.4 to 0.3), and rivaroxaban versus dabigatran (-0.1%; 95% CI: -0.5 to 0.2). The risk differences for DOACs versus VKA were all significant: -0.4% (95% CI: -0.7 to -0.1) for apixaban, -0.4% (95% CI: -0.7 to -0.03) for dabigatran, and -0.5% (95% CI: -0.8 to -0.2) for rivaroxaban. CONCLUSIONS: No significant risk differences of MI were found in the direct comparisons of DOACs, and DOACs were all associated with a significant risk reduction of MI compared with VKA.
Authors: Ihsan Gadi; Sameen Fatima; Berend Isermann; Khurrum Shahzad; Ahmed Elwakiel; Sumra Nazir; Moh'd Mohanad Al-Dabet; Rajiv Rana; Fabian Bock; Jayakumar Manoharan; Dheerendra Gupta; Ronald Biemann; Bernhard Nieswandt; Ruediger Braun-Dullaeus; Christian Besler; Markus Scholz; Robert Geffers; John H Griffin; Charles T Esmon; Shrey Kohli Journal: Circ Res Date: 2020-12-23 Impact factor: 17.367