Key result
Dabigatran is linked to ~43% lower mortality and renal failure vs rivaroxaban and edoxaban in AF.
Why the study?
Comparative effectiveness data for dabigatran, rivaroxaban, and edoxaban regarding mortality and renal outcomes remain limited, especially in Asian populations.
Do rivaroxaban and edoxaban compared to dabigatran affect mortality and renal outcomes in Asian patients with atrial fibrillation?
Observational (n=4,392)
Yes
Do rivaroxaban and edoxaban compared to dabigatran affect mortality and renal outcomes in Asian patients with atrial fibrillation?
Hazard Ratio: 1.76 (95% CI 1.32–2.342)
p-value: p=<0.0001
In a real-world Asian cohort of AF patients, dabigatran was associated with lower risks of all-cause mortality and renal failure compared to rivaroxaban and edoxaban, with no significant difference in major bleeding.
May favor dabigatran in Asian AF for mortality and renal outcomes; leaves open need for randomized confirmation.
Introduction Atrial fibrillation (AF) significantly increases stroke and systemic embolism risk. Direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, and edoxaban offer superior pharmacokinetic profiles compared to warfarin. However, comparative effectiveness data on mortality and renal outcomes, especially in Asian populations, remain limited. Methods This retrospective, multi-center observational study analyzed data from three Taiwanese hospitals, encompassing 4,392 adult AF patients (July 2013-December 2020) treated with dabigatran (n=803), rivaroxaban (n=2,834), or edoxaban (n=755). Two-year follow-up assessed all-cause mortality, cardiovascular mortality, renal failure, acute kidney injury (AKI), and ≥30% estimated glomerular filtration rate (eGFR) decline. Propensity score weighting addressed confounding biases. Results Compared to dabigatran, rivaroxaban and edoxaban showed significantly higher all-cause mortality risks (rivaroxaban HR 1.76, 95% CI 1.320-2.342, p<0.0001; edoxaban HR 1.55, 95% CI 1.081-2.218, p=0.0171). Dabigatran also demonstrated superior renal protection, with rivaroxaban and edoxaban exhibiting significantly higher risks of renal failure (rivaroxaban HR 1.66, 95% CI 1.079-2.538, p=0.0210; edoxaban HR 1.80, 95% CI 1.075-3.012, p=0.0254). No significant differences in major bleeding were observed across DOACs after propensity score adjustment. Conclusion This real-world study supports dabigatran's superior efficacy in reducing mortality and renal failure risk among Asian AF patients compared to rivaroxaban and edoxaban.
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Yeh et al. (2025) conducted an observational in Atrial fibrillation (n=4,392). Rivaroxaban and edoxaban vs. Dabigatran was evaluated on all-cause mortality (HR 1.76, 95% CI 1.320-2.342, p=<0.0001). Rivaroxaban and edoxaban were associated with higher all-cause mortality than dabigatran (rivaroxaban HR 1.76, P<0.0001; edoxaban HR 1.55, P=0.0171) in Asian patients with atrial fibrillation.
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