Why the study?
Do direct oral anticoagulants improve safety and effectiveness outcomes compared to vitamin K antagonists in patients with nonvalvular atrial fibrillation for secondary prevention?
Do direct oral anticoagulants improve safety and effectiveness outcomes compared to vitamin K antagonists in patients with nonvalvular atrial fibrillation for secondary prevention?
In a real-world setting, direct oral anticoagulants are associated with lower risks of all-cause mortality, cardiovascular mortality, and hemorrhagic stroke compared to vitamin K antagonists for secondary prevention in nonvalvular atrial fibrillation.
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Supports feasibility of near-real-time DOAC monitoring in AF; leaves open larger validation before routine adoption.
BACKGROUND: Real-time monitoring is used to the ends of postmarketing observational research on newly marketed drugs. We implemented a pilot near-real-time monitoring program on the test case of oral anticoagulants. Specifically, we evaluated the safety and effectiveness of direct oral anticoagulants compared to vitamin K antagonists in nonvalvular atrial fibrillation secondary prevention during 2013-2015 in the Lazio Region, Italy. METHODS AND RESULTS: A cohort study was conducted using a sequential propensity-score-matched new user parallel-cohort design. Sequential analyses were performed using Cox models. Overall, 10 742 patients contributed to the analyses. Compared with vitamin K antagonists, direct oral anticoagulant use was associated with a reduction of all-cause mortality (0.81; 95% confidence interval [CI] 0.66-0.99), cardiovascular mortality (0.71; 95% CI 0.54-0.93), myocardial infarction (0.67; 95% CI 0.43-1.04), ischemic stroke (0.87; 95% CI 0.52-1.45), hemorrhagic stroke (0.25; 95% CI 0.07-0.88), and with a nonsignificant increase of gastrointestinal bleeding (1.26; 95% CI 0.69-2.30). CONCLUSIONS: The present pilot study is a cornerstone to develop real-time monitoring for new drugs in our region.
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Mayer et al. (2018) studied this question.
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