December 19, 2017Annals of Internal Medicine
Outcomes of Dabigatran and Warfarin for Atrial Fibrillation in Contemporary Practice
Key result
Dabigatran use in adults with atrial fibrillation was associated with similar rates of ischemic stroke compared to warfarin (0.80 vs. 0.94 events per 100 person-years; HR 0.92; 95% CI 0.65-1.28).
Why the study?
Does dabigatran reduce the incidence of stroke, bleeding, and myocardial infarction compared to warfarin in adults with atrial fibrillation in contemporary practice?
Population
50,578 adults with atrial fibrillation initiating dabigatran or warfarin therapy between November 2010 and…
Comparison
Dabigatran vs Warfarin (propensity score-matched)
Design
Cohort
Authors
Discussion
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Implication
Dabigatran was associated with similar ischemic stroke rates as warfarin in AF; leaves open comparative safety for prospective confirmation.
Study Design
Type
Cohort (n=50,578)
Multicenter
Yes
Structured PICO
Does dabigatran reduce the incidence of stroke, bleeding, and myocardial infarction compared to warfarin in adults with atrial fibrillation in contemporary practice?
P
Population
50,578 propensity score-matched adults with atrial fibrillation initiating dabigatran or warfarin therapy.
E
Exposure
Dabigatran
C
Comparator
Warfarin (propensity score-matched)
O
Outcome
Incidence of ischemic stroke, intracranial hemorrhage, extracranial bleeding, and myocardial infarction identified from hospital claimshard clinical
Main Result
Hazard Ratio: 0.92 (95% CI 0.65–1.28)
Absolute Event Rate: 0.8% vs 0.94%
In real-world practice, dabigatran demonstrated lower intracranial bleeding but potentially higher myocardial infarction risk compared to warfarin, with similar rates of ischemic stroke and extracranial hemorrhage.
Limitations
- Inability to examine outcomes by dabigatran dose (unacceptable covariate balance between matched patients)
- Inability to examine quality of warfarin anticoagulation (few patients receiving warfarin had available international normalized ratio values)
Cite This Study
Go et al. (2017) conducted a cohort in Atrial Fibrillation (n=50,578). Dabigatran vs. Warfarin was evaluated on Ischemic stroke (HR 0.92, 95% CI 0.65 to 1.28). Dabigatran use in adults with atrial fibrillation was associated with similar rates of ischemic stroke compared to warfarin (0.80 vs. 0.94 events per 100 person-years; HR 0.92; 95% CI 0.65-1.28).