What question did this study set out to answer?

This study aims to evaluate the effectiveness and safety of NOACs compared to warfarin in anticoagulant-naïve patients diagnosed with atrial fibrillation.

June 16, 2016BMJOpen Access

Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study

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Why the study?

Do NOACs (dabigatran, rivaroxaban, apixaban) reduce ischemic stroke, systemic embolism, or death in anticoagulant-naïve patients with non-valvular atrial fibrillation compared to warfarin?

Population

61,678 patients with non-valvular atrial fibrillation who were naïve to oral anticoagulants and had no…

Comparison

Non-vitamin K antagonist oral anticoagulants… vs Warfarin.

Design

Cohort

Follow-up

1 year

Authors

TLTorben Bjerregaard LarsenGeneral Cardiology FSFlemming SkjøthCross-Cutting Cardiology PNPeter Brønnum NielsenPreventive Cardiology

Discussion

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Implication

Supports NOAC alternatives to warfarin in anticoagulant-naïve non-valvular AF; leaves open confirmation by randomized trials.

Key Points

This study aims to evaluate the effectiveness and safety of NOACs compared to warfarin in anticoagulant-naïve patients diagnosed with atrial fibrillation.
Observational nationwide cohort study involving 61,678 patients from three Danish databases between August 2011 and October 2015.
Patients were grouped based on their anticoagulant treatment: warfarin, dabigatran, rivaroxaban, and apixaban.
Main outcomes included ischaemic stroke, systemic embolism, death, and various bleeding events.
Rivaroxaban showed lower annual rates of ischaemic stroke or systemic embolism (3.0% vs 3.3%) compared to warfarin (HR 0.83; 95% CI 0.69 to 0.99).
Apixaban and dabigatran significantly reduced the annual risk of death compared to warfarin (5.2% and 2.7% vs 8.5%, HR 0.65; 95% CI 0.56 to 0.75 and HR 0.63; 95% CI 0.48 to 0.82).
Annual rates of any bleeding were significantly lower for apixaban (3.3%) and dabigatran (2.4%) than warfarin (5.0%), while rivaroxaban had comparable rates to warfarin (5.3%).

Structured PICO

Do NOACs (dabigatran, rivaroxaban, apixaban) reduce ischemic stroke, systemic embolism, or death in anticoagulant-naïve patients with non-valvular atrial fibrillation compared to warfarin?

Population

61,678 patients with non-valvular atrial fibrillation who were naïve to oral anticoagulants and had no previous indication for valvular atrial fibrillation or venous thromboembolism.

Intervention

Non-vitamin K antagonist oral anticoagulants (NOACs): dabigatran 150 mg, rivaroxaban 20 mg, or apixaban 5 mg.

Comparator

Warfarin.

Outcome

Ischaemic stroke; a composite of ischaemic stroke or systemic embolism; death; and a composite of ischaemic stroke, systemic embolism, or death.composite

In routine clinical practice, NOACs are safe and effective alternatives to warfarin for stroke prevention in non-valvular atrial fibrillation, with apixaban and dabigatran demonstrating lower risks of death and bleeding.

Cite This Study

Larsen et al. (2016) studied this question.

synapsesocial.com/papers/69ffcace7e61d2a3f0c22e17 https://doi.org/10.1136/bmj.i3189

Topics

Atrial fibrillation Anticoagulation in AF Persistent AF management

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Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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