Intracranial Hemorrhage Mortality in Atrial Fibrillation Patients Treated With Dabigatran or Warfarin
Key result
Dabigatran was not associated with higher in-hospital mortality compared with warfarin in atrial fibrillation patients with intracranial bleeding (20% vs 22%; RR 0.93; 95% CI 0.62-1.37).
Why the study?
Does dabigatran increase in-hospital mortality compared to warfarin in atrial fibrillation patients who develop intracranial bleeding?
Population
2,391 atrial fibrillation patients admitted to a hospital with a primary diagnosis of intracranial bleeding…
Comparison
Dabigatran vs Warfarin
Design
Cohort
Follow-up
in-hospital
Authors
Discussion
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Member takes
Implication
May alleviate reversal concerns for dabigatran in AF-related intracranial bleeding; observational data leaves open need for prospective confirmation.
Key Points
- To evaluate in-hospital mortality differences between dabigatran and warfarin among atrial fibrillation patients admitted with intracranial bleeding in a real-world setting.
- Analyzed claims from the Truven Health MarketScan Research Databases for patients with atrial fibrillation hospitalized with a primary diagnosis of intracranial bleeding (N=2,391; 2,290 on warfarin, 101 on dabigatran).
- Calculated propensity score-adjusted risk ratios and 95% confidence intervals for in-hospital mortality using relative risk regression across overall cases and intracranial bleeding subtypes.
- In-hospital mortality was 20% in dabigatran users and 22% in warfarin users (531 total in-hospital deaths).
- Propensity score-adjusted risk ratio for in-hospital mortality in dabigatran versus warfarin users was 0.93 (95% CI, 0.62–1.37).
- Mortality associations remained consistent across intracerebral hemorrhage, subarachnoid hemorrhage, and subdural hematoma subtypes.
Study Design
Type
Cohort (n=2,391)
Structured PICO
Does dabigatran increase in-hospital mortality compared to warfarin in atrial fibrillation patients who develop intracranial bleeding?
P
Population
2,391 patients with atrial fibrillation admitted to a hospital with a primary diagnosis of intracranial bleeding in the United States.
E
Exposure
Dabigatran
C
Comparator
Warfarin
O
Outcome
In-hospital mortalityhard clinical
Main Result
Relative Risk: 0.93 (95% CI 0.62–1.37)
Absolute Event Rate: 20% vs 22%
In real-world atrial fibrillation patients who develop intracranial bleeding, prior use of dabigatran is not associated with higher in-hospital mortality compared to warfarin, alleviating concerns regarding the lack of a reversal agent.
Cite This Study
Alonso et al. (2014) conducted a cohort in Atrial fibrillation with intracranial bleeding (n=2,391). Dabigatran vs. Warfarin was evaluated on In-hospital mortality (RR 0.93, 95% CI 0.62-1.37). Dabigatran was not associated with higher in-hospital mortality compared with warfarin in atrial fibrillation patients with intracranial bleeding (20% vs 22%; RR 0.93; 95% CI 0.62-1.37).