Key result
Dabigatran is linked to ~24% lower S. aureus bacteremia risk vs. factor Xa-inhibitors in AF.
Why the study?
Dabigatran reduces Staphylococcus aureus virulence in vitro and in vivo, but whether it reduces S. aureus infections in humans remains undetermined.
Does dabigatran reduce the incidence of Staphylococcus aureus bacteremia in patients with atrial fibrillation compared to factor Xa-inhibitors?
Cohort (n=112,537)
Yes
Does dabigatran reduce the incidence of Staphylococcus aureus bacteremia in patients with atrial fibrillation compared to factor Xa-inhibitors?
Relative Risk: 0.76 (95% CI 0.63–0.93)
Absolute Event Rate: 22.8% vs 33.8%
In patients with atrial fibrillation, dabigatran is associated with a lower risk of Staphylococcus aureus bacteremia compared to factor Xa-inhibitors, translating preclinical findings of reduced virulence into clinical evidence.
Should not yet alter anticoagulant selection in AF; hypothesis-generating for dabigatran's anti-staphylococcal effect beyond preclinical models.
BACKGROUND: Treatment with dabigatran, an oral direct thrombin inhibitor, reduces the virulence of Staphylococcus aureus in in vitro and in vivo models. However, it remains to be determined whether dabigatran reduces the risk of S. aureus infections in humans. We investigated the incidence rate of S. aureus bacteremia (SAB) in patients with atrial fibrillation treated with the direct thrombin inhibitor dabigatran compared with patients treated with the factor Xa-inhibitors rivaroxaban, apixaban, and edoxaban. METHODS: In this observational cohort study, 112 537 patients with atrial fibrillation who initiated treatment with direct oral anticoagulants (August 2011-December 2017) were identified from Danish nationwide registries. The incidence rates of SAB in patients treated with dabigatran versus patients treated with the factor Xa-inhibitors were examined by multivariable Cox regression accounting for time-dynamic changes in exposure status during follow-up. RESULTS: A total of 112 537 patients were included. During a median follow-up of 2.0 years, 186 patients in the dabigatran group and 356 patients in the factor Xa-inhibitor group were admitted with SAB. The crude incidence rate of SAB was lower in the dabigatran group compared with the factor Xa-inhibitor group (22.8 [95% confidence interval [CI], 19.7-26.3] and 33.8 [95% CI, 30.5-37.6] events per 10 000 person-years, respectively). In adjusted analyses, dabigatran was associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio, .76; 95% CI, .63-.93). CONCLUSIONS: Treatment with dabigatran was associated with a significantly lower incidence rate of SAB compared with treatment with factor Xa-inhibitors.
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Butt et al. (2020) conducted a cohort in Atrial fibrillation (n=112,537). Dabigatran vs. Factor Xa-inhibitors (rivaroxaban, apixaban, edoxaban) was evaluated on Staphylococcus aureus bacteremia (SAB) (IRR 0.76, 95% CI 0.63-0.93). Dabigatran was associated with a significantly lower incidence rate of Staphylococcus aureus bacteremia compared with factor Xa-inhibitors in patients with atrial fibrillation (IRR 0.76).
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