Treatment with VKA (43%) and rivaroxaban (42%) was associated with a higher rate of major adverse events compared to dabigatran (31%, p<0.01), driven by an increased risk of hemorrhagic events.
Cohort (n=2,983)
Does the type of oral anticoagulation (VKA, rivaroxaban, or dabigatran) affect the risk of major adverse events in patients with atrial fibrillation?
In Polish patients with atrial fibrillation, dabigatran was associated with a lower risk of major adverse events, driven by fewer hemorrhagic events compared to VKA and rivaroxaban.
p-value: p=<0.01
Background: We aimed to compare long-term outcomes in Polish patients with atrial fibrillation (AF) according to oral anticoagulation (OAC) type and to evaluate the predictive value of common thromboembolic and bleeding risk scores. Methods: Data from the CRAFT trial (NCT02987062) were included. The primary study endpoint was major adverse event (MAE; all-cause death, thromboembolic and hemorrhagic event) during the mean four-year follow-up period. Results: Out of 2983 patients with available follow-up data, 1686 (56%) were prescribed with vitamin K antagonist (VKA), 891 (30%) with rivaroxaban and 406 (14%) with dabigatran. Predominance of elderly and female patients with previous history of thromboembolic and hemorrhagic events was observed within rivaroxaban (vs. other OAC) group. Higher rate of MAEs and its components was observed in patients on VKA followed by rivaroxaban as compared to patients on dabigatran (43% vs. 42% vs. 31%, p < 0.01). After group matching based on clinical characteristics, higher risk of hemorrhagic events in VKA (vs. dabigatran) and rivaroxaban (vs. dabigatran) group were observed. The available thromboembolic (CHA2DS2-VASs, ATRIA, R2CHADS2) and bleeding (HAS-BLED, ATRIA, ORBIT) risk scores showed poor prediction value. Conclusions: Despite no difference in the thromboembolic event rate, treatment with VKA and rivaroxaban was associated with a significant increase in the risk of hemorrhagic events.
Balsam et al. (Mon,) conducted a cohort in Atrial fibrillation (n=2,983). Oral anticoagulation (VKA, rivaroxaban, dabigatran) vs. Between-group comparison was evaluated on Major adverse event (MAE; all-cause death, thromboembolic and hemorrhagic event) (p=<0.01). Treatment with VKA (43%) and rivaroxaban (42%) was associated with a higher rate of major adverse events compared to dabigatran (31%, p<0.01), driven by an increased risk of hemorrhagic events.