Dabigatran Versus Warfarin for Atrial Fibrillation in Real-World Clinical Practice
| Autor: | Eunice Kym, Marina Dolginsky, Kathleen B. Orrico, Laura Nolting, Robert J. Romanelli |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty 030204 cardiovascular system & hematology Antithrombins Dabigatran 03 medical and health sciences 0302 clinical medicine Risk Factors Atrial Fibrillation medicine Humans 030212 general & internal medicine Stroke Aged business.industry Hazard ratio Age Factors Warfarin Anticoagulants Retrospective cohort study Atrial fibrillation medicine.disease Treatment Outcome Anesthesia Meta-analysis Emergency medicine Female Observational study Gastrointestinal Hemorrhage Cardiology and Cardiovascular Medicine business Intracranial Hemorrhages medicine.drug |
| Zdroj: | Circulation: Cardiovascular Quality and Outcomes. 9:126-134 |
| ISSN: | 1941-7705 1941-7713 |
| DOI: | 10.1161/circoutcomes.115.002369 |
| Popis: | Background— Trial data for the benefits and risks of dabigatran versus warfarin in the treatment of nonvalvular atrial fibrillation are lacking. We sought to review real-world observational evidence for the comparative effectiveness and safety of these agents. Methods and Results— A systematic search of multiple databases was conducted from first available date to March 10, 2015 for longitudinal, observational studies comparing dabigatran with warfarin. Two reviewers evaluated studies for eligibility and extracted hazard ratios for ischemic stroke and gastrointestinal and intracranial bleeding. hazard ratios were pooled using random-effects meta-analysis. Metaregression was performed to assess treatment-effect heterogeneity. We identified 232 unique citations. Seven retrospective cohort studies met study eligibility criteria, with 348 750 patients and a mean follow-up of 2.2 years. In pooled analyses, dabigatran-150 mg was not superior to warfarin in preventing stroke (hazard ratio, 0.92; 95% confidence interval, 0.84–1.01; P =0.066), but had a significantly lower hazard of intracranial bleeding (0.44; 0.34–0.59; P P =0.041), which was potentiated in studies of older (elderly) versus younger populations (median/mean age, ≥75 versus P =0.020). Conclusions— In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but—particularly among the elderly—a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial. |
| Databáze: | OpenAIRE |
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