Ole-Christian W Rutherford1,2, Christian Jonasson3, Waleed Ghanima2,4, Fabian Söderdahl5, Sigrun Halvorsen2,6. 1. Department of Cardiology, Østfold Hospital Trust, PO Box 300, 1714 Grålum, Sarpsborg, Norway. 2. Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway. 3. HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway. 4. Department of Haematology, Østfold Hospital Trust, PO Box 300, 1714 Grålum. Sarpsborg, Norway. 5. Statisticon AB, Klara Södra kyrkogata 1, 111 52 Stockholm, Sweden. 6. Department of Cardiology, Oslo University Hospital Ullevål, PO Box 4956, Nydalen. NO-0424 Oslo, Norway.
Abstract
AIMS: The aim of this study was to compare the risk of stroke or systemic embolism (SE) and major bleeding in patients with atrial fibrillation (AF) using dabigatran, rivaroxaban, and apixaban in routine clinical practice. METHODS AND RESULTS: Using nationwide registries in Norway from January 2013 to December 2017, we established a cohort of 52 476 new users of non-vitamin K antagonist oral anticoagulants (NOACs) with AF. Users of individual NOACs were matched 1:1 on the propensity score to create three pairwise-matched cohorts: dabigatran vs. rivaroxaban (20 504 patients), dabigatran vs. apixaban (20 826 patients), and rivaroxaban vs. apixaban (27 398 patients). Hazard ratios (HRs) for the risk of stroke or SE and major bleeding were estimated. In the propensity-matched comparisons of the risk of stroke or SE, the HRs were 0.88 [95% confidence interval (CI) 0.76-1.02] for dabigatran vs. rivaroxaban, 0.88 (95% CI 0.75-1.02) for dabigatran vs. apixaban, and 1.00 (95% CI 0.89-1.14) for apixaban vs. rivaroxaban. For the risk of major bleeding, the HRs were 0.75 (95% CI 0.64-0.88) for dabigatran vs. rivaroxaban, 1.03 (95% CI 0.85-1.24) for dabigatran vs. apixaban, and 0.79 (95% CI 0.68-0.91) for apixaban vs. rivaroxaban. CONCLUSION: In this nationwide study of patients with AF in Norway, we found no statistically significant differences in risk of stroke or SE in propensity-matched comparisons between dabigatran, rivaroxaban, and apixaban. However, dabigatran and apixaban were both associated with significantly lower risk of major bleeding compared with rivaroxaban.
AIMS: The aim of this study was to compare the risk of stroke or systemic embolism (SE) and major bleeding in patients with atrial fibrillation (AF) using dabigatran, rivaroxaban, and apixaban in routine clinical practice. METHODS AND RESULTS: Using nationwide registries in Norway from January 2013 to December 2017, we established a cohort of 52 476 new users of non-vitamin K antagonist oral anticoagulants (NOACs) with AF. Users of individual NOACs were matched 1:1 on the propensity score to create three pairwise-matched cohorts: dabigatran vs. rivaroxaban (20 504 patients), dabigatran vs. apixaban (20 826 patients), and rivaroxaban vs. apixaban (27 398 patients). Hazard ratios (HRs) for the risk of stroke or SE and major bleeding were estimated. In the propensity-matched comparisons of the risk of stroke or SE, the HRs were 0.88 [95% confidence interval (CI) 0.76-1.02] for dabigatran vs. rivaroxaban, 0.88 (95% CI 0.75-1.02) for dabigatran vs. apixaban, and 1.00 (95% CI 0.89-1.14) for apixaban vs. rivaroxaban. For the risk of major bleeding, the HRs were 0.75 (95% CI 0.64-0.88) for dabigatran vs. rivaroxaban, 1.03 (95% CI 0.85-1.24) for dabigatran vs. apixaban, and 0.79 (95% CI 0.68-0.91) for apixaban vs. rivaroxaban. CONCLUSION: In this nationwide study of patients with AF in Norway, we found no statistically significant differences in risk of stroke or SE in propensity-matched comparisons between dabigatran, rivaroxaban, and apixaban. However, dabigatran and apixaban were both associated with significantly lower risk of major bleeding compared with rivaroxaban.
Authors: Alexandros A Polymeris; Annaelle Zietz; Fabian Schaub; Louisa Meya; Christopher Traenka; Sebastian Thilemann; Benjamin Wagner; Lisa Hert; Valerian L Altersberger; David J Seiffge; Flurina Lyrer; Tolga Dittrich; Ines Piot; Josefin Kaufmann; Lea Barone; Ludvig Dahlheim; Sophie Flammer; Nikolaos S Avramiotis; Nils Peters; Gian Marco De Marchis; Leo H Bonati; Henrik Gensicke; Stefan T Engelter; Philippe A Lyrer Journal: Eur Stroke J Date: 2022-05-10
Authors: Benjamin J R Buckley; Deirdre A Lane; Peter Calvert; Juqian Zhang; David Gent; C Daniel Mullins; Paul Dorian; Shun Kohsaka; Stefan H Hohnloser; Gregory Y H Lip Journal: J Clin Med Date: 2022-06-30 Impact factor: 4.964
Authors: Joris J Komen; Eibert R Heerdink; Olaf H Klungel; Aukje K Mantel-Teeuwisse; Tomas Forslund; Björn Wettermark; Paul Hjemdahl Journal: Eur Heart J Cardiovasc Pharmacother Date: 2021-04-09
Authors: Iwona Gorczyca; Olga Jelonek; Beata Uziębło-Życzkowska; Magdalena Chrapek; Małgorzata Maciorowska; Maciej Wójcik; Robert Błaszczyk; Agnieszka Kapłon-Cieślicka; Monika Gawałko; Monika Budnik; Tomasz Tokarek; Renata Rajtar-Salwa; Jacek Bil; Michał Wojewódzki; Anna Szpotowicz; Janusz Bednarski; Elwira Bakuła-Ostalska; Anna Tomaszuk-Kazberuk; Anna Szyszkowska; Marcin Wełnicki; Artur Mamcarz; Beata Wożakowska-Kapłon Journal: J Clin Med Date: 2020-11-05 Impact factor: 4.241