Effectiveness and safety of direct oral anticoagulants compared to warfarin in treatment naïve non-valvular atrial fibrillation patients in the US Department of defense population

Autor: Qisu Zhang, Thomas C. Shank, Kiran Gupta, Jack Mardekian, Anagha Nadkarni, Oluwaseyi Dina, Jeffrey Trocio, Allison Keshishian
Rok vydání: 2019
Předmět:
Male
lcsh:Diseases of the circulatory (Cardiovascular) system
Administration
Oral
Major bleeding
030204 cardiovascular system & hematology
Direct oral anticoagulants
0302 clinical medicine
Rivaroxaban
Risk Factors
Atrial Fibrillation
030212 general & internal medicine
Stroke
education.field_of_study
Atrial fibrillation
Middle Aged
United States Department of Defense
Dabigatran
Treatment Outcome
Female
Apixaban
Cardiology and Cardiovascular Medicine
Research Article
medicine.drug
Adult
medicine.medical_specialty
Adolescent
Pyridones
Stroke/systemic embolism
Population
Hemorrhage
Non-valvular atrial fibrillation
Lower risk
Risk Assessment
Young Adult
03 medical and health sciences
Internal medicine
medicine
Humans
cardiovascular diseases
education
Aged
Retrospective Studies
business.industry
Warfarin
Anticoagulants
medicine.disease
United States
lcsh:RC666-701
Pyrazoles
business
Zdroj: BMC Cardiovascular Disorders
BMC Cardiovascular Disorders, Vol 19, Iss 1, Pp 1-10 (2019)
ISSN: 1471-2261
DOI: 10.1186/s12872-019-1116-1
Popis: Background Clinical trials have demonstrated that direct oral anticoagulants (DOACs) are at least non-inferior to warfarin in reducing the risk of stroke/systemic embolism (SE) among patients with non-valvular atrial fibrillation (NVAF), but the comparative risk of major bleeding varies between DOACs and warfarin. Using US Department of Defense (DOD) data, this study compared the risk of stroke/SE and major bleeding for DOACs relative to warfarin. Methods Adult patients with ≥1 pharmacy claim for apixaban, dabigatran, rivaroxaban, or warfarin from 01 Jan 2013–30 Sep 2015 were selected. Patients were required to have ≥1 medical claim for atrial fibrillation during the 12-month baseline period. Patients with a warfarin or DOAC claim during the 12-month baseline period were excluded. Each DOAC cohort was matched to the warfarin cohort using propensity score matching (PSM). Cox proportional hazards models were conducted to evaluate the risk of stroke/SE and major bleeding of each DOAC vs warfarin. Results Of 41,001 identified patients, there were 3691 dabigatran-warfarin, 8226 rivaroxaban-warfarin, and 7607 apixaban-warfarin matched patient pairs. Apixaban was the only DOAC found to be associated with a significantly lower risk of stroke/SE (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.39, 0.77; p
Databáze: OpenAIRE
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