Why the study?
Do direct oral anticoagulants (dabigatran, rivaroxaban, apixaban) reduce the risk of bleeding, ischaemic stroke, venous thromboembolism, and all-cause mortality compared with warfarin in patients with and without atrial fibrillation?
Population
196,061 patients who were new users of oral anticoagulants
Comparison
Direct oral anticoagulants vs Warfarin
Design
Cohort, open
Key result
Apixaban was associated with a decreased risk of major bleeding compared with warfarin in patients with atrial fibrillation (HR 0.66; 95% CI 0.54-0.79).
Authors
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May inform apixaban preference over warfarin to lower bleeding in AF; hypothesis-generating and requires RCT confirmation.
Cohort (n=196,061)
Open-label
Yes
Do direct oral anticoagulants (dabigatran, rivaroxaban, apixaban) reduce the risk of bleeding, ischaemic stroke, venous thromboembolism, and all-cause mortality compared with warfarin in patients with and without atrial fibrillation?
Effect estimate: HR 0.66 (95% CI 0.54-0.79)
In a real-world UK primary care cohort, apixaban demonstrated the most favorable safety profile regarding bleeding compared to warfarin, whereas rivaroxaban and low-dose apixaban were associated with higher all-cause mortality.
Vinogradova et al. (2018) conducted a cohort in Patients with and without atrial fibrillation requiring anticoagulation (n=196,061). Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban) vs. Warfarin was evaluated on Major bleeding leading to hospital admission or death (HR 0.66, 95% CI 0.54-0.79). Apixaban was associated with a decreased risk of major bleeding compared with warfarin in patients with atrial fibrillation (HR 0.66; 95% CI 0.54-0.79).