Key result
DOACs show similar stroke prevention, but dabigatran and apixaban linked to less major bleeding than rivaroxaban.
Why the study?
The risk of stroke or systemic embolism and major bleeding needed to be compared among patients with AF using dabigatran, rivaroxaban, and apixaban in routine clinical practice.
Do different NOACs (dabigatran, rivaroxaban, apixaban) differ in effectiveness and safety for stroke prevention in patients with atrial fibrillation?
Cohort (n=52,476)
Do different NOACs (dabigatran, rivaroxaban, apixaban) differ in effectiveness and safety for stroke prevention in patients with atrial fibrillation?
In routine clinical practice, dabigatran, rivaroxaban, and apixaban offer similar stroke prevention in AF, but dabigatran and apixaban have a more favorable major bleeding profile than rivaroxaban.
Answers are grounded in this paper and cite their sources.
Supports preferring dabigatran or apixaban over rivaroxaban to reduce bleeding in AF; hypothesis-generating and should not yet change practice.
AIMS: The aim of this study was to compare the risk of stroke or systemic embolism (SE) and major bleeding in patients with atrial fibrillation (AF) using dabigatran, rivaroxaban, and apixaban in routine clinical practice. METHODS AND RESULTS: Using nationwide registries in Norway from January 2013 to December 2017, we established a cohort of 52 476 new users of non-vitamin K antagonist oral anticoagulants (NOACs) with AF. Users of individual NOACs were matched 1:1 on the propensity score to create three pairwise-matched cohorts: dabigatran vs. rivaroxaban (20 504 patients), dabigatran vs. apixaban (20 826 patients), and rivaroxaban vs. apixaban (27 398 patients). Hazard ratios (HRs) for the risk of stroke or SE and major bleeding were estimated. In the propensity-matched comparisons of the risk of stroke or SE, the HRs were 0.88 [95% confidence interval (CI) 0.76-1.02] for dabigatran vs. rivaroxaban, 0.88 (95% CI 0.75-1.02) for dabigatran vs. apixaban, and 1.00 (95% CI 0.89-1.14) for apixaban vs. rivaroxaban. For the risk of major bleeding, the HRs were 0.75 (95% CI 0.64-0.88) for dabigatran vs. rivaroxaban, 1.03 (95% CI 0.85-1.24) for dabigatran vs. apixaban, and 0.79 (95% CI 0.68-0.91) for apixaban vs. rivaroxaban. CONCLUSION: In this nationwide study of patients with AF in Norway, we found no statistically significant differences in risk of stroke or SE in propensity-matched comparisons between dabigatran, rivaroxaban, and apixaban. However, dabigatran and apixaban were both associated with significantly lower risk of major bleeding compared with rivaroxaban.
No takes yet. Share an insight, caveat, or question.
Rutherford et al. (2020) conducted a cohort in Atrial Fibrillation (n=52,476). Dabigatran vs. Rivaroxaban was evaluated on Time to first stroke (haemorrhagic or ischaemic) or systemic embolism (SE) (HR 0.88, 95% CI 0.76-1.02). In propensity-matched comparisons, there were no significant differences in the risk of stroke or systemic embolism among dabigatran, rivaroxaban, and apixaban, though dabigatran and apixaban were associated with a significantly lower risk of major bleeding compared to rivaroxaban.
Synapse has enriched 10 related papers. Consider them for comparative context: