Direct oral anticoagulants were associated with lower risks of hospitalization for ischemic stroke/systemic embolism (HR 0.64; 95% CI 0.46-0.90) and major bleeding compared with warfarin.
Cohort (n=10,209)
Yes
Do DOACs reduce hospitalization for ischemic stroke/systemic embolism and major bleeding compared to warfarin in patients with atrial fibrillation and chronic liver disease?
In patients with atrial fibrillation and chronic liver disease, DOACs (particularly apixaban) are associated with lower risks of ischemic stroke/systemic embolism and major bleeding compared to warfarin.
Effect estimate: HR 0.64 (95% CI 0.46-0.90)
Absolute Event Rate: 2.2% vs 4.4%
BACKGROUND: The benefit-risk profile of direct oral anticoagulants (DOACs) compared with warfarin, and between DOACs in patients with atrial fibrillation (AF) and chronic liver disease is unclear. METHODS: We conducted a new-user, retrospective cohort study of patients with AF and chronic liver disease who were enrolled in a large, US-based administrative database between January 1, 2011, and December 31, 2017. We assessed the effectiveness and safety of DOACs (as a class and individually) compared with warfarin, and between DOACs in patients with AF and chronic liver disease. The primary outcomes were hospitalization for ischemic stroke/systemic embolism and hospitalization for major bleeding. Inverse probability treatment weights were used to balance the treatment groups on measured confounders. RESULTS: Overall, 10 209 participants were included, with 4421 (43.2%) on warfarin, 2721 (26.7%) apixaban, 2211 (21.7%) rivaroxaban, and 851 (8.3%) dabigatran. The incidence rates per 100 person-years for ischemic stroke/systemic embolism were 2.2, 1.4, 2.6, and 4.4 for DOACs as a class, apixaban, rivaroxaban, and warfarin, respectively. The incidence rates per 100 person-years for major bleeding were 7.9, 6.5, 9.1, and 15.0 for DOACs as a class, apixaban, rivaroxaban, and warfarin, respectively. After inverse probability treatment weights, the risk of hospitalization for ischemic stroke/systemic embolism was significantly lower between DOACs as a class (hazard ratio HR, 0.64 95% CI, 0.46-0.90) or apixaban (HR, 0.40 95% CI, 0.19-0.82) compared with warfarin, but not significantly different between rivaroxaban versus warfarin (HR, 0.76 95% CI, 0.47-1.21) or rivaroxaban versus apixaban (HR, 1.73 95% CI, 0.91-3.29). Compared with warfarin, the risk of hospitalization for major bleeding was lower with DOACs as a class (HR, 0.69 95% CI, 0.58-0.82), apixaban (HR, 0.60 95% CI, 0.46-0.78), and rivaroxaban (HR, 0.79 95% CI, 0.62-1.0). However, the risk of hospitalization for major bleeding was higher for rivaroxaban versus apixaban (HR, 1.59 95% CI, 1.18-2.14). CONCLUSIONS: Among patients with AF and chronic liver disease, DOACs as a class were associated with lower risks of hospitalization for ischemic stroke/systemic embolism and major bleeding versus warfarin. However, the incidence of clinical outcomes among patients with AF and chronic liver disease varied between individual DOACs and warfarin, and in head-to-head DOAC comparisons.
Lawal et al. (Fri,) conducted a cohort in Atrial fibrillation and chronic liver disease (n=10,209). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Hospitalization for ischemic stroke/systemic embolism (HR 0.64, 95% CI 0.46-0.90). Direct oral anticoagulants were associated with lower risks of hospitalization for ischemic stroke/systemic embolism (HR 0.64; 95% CI 0.46-0.90) and major bleeding compared with warfarin.
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