Key result
DOACs are linked to ~50% lower mortality versus VKAs in low bleeding risk patients.
Why the study?
Limited real-world data are available on the survival of patients with nonvalvular AF treated with VKAs versus DOACs, particularly during the early treatment period.
Do DOACs reduce mortality compared to VKAs in patients with nonvalvular atrial fibrillation?
Cohort (n=144,394)
Yes
Do DOACs reduce mortality compared to VKAs in patients with nonvalvular atrial fibrillation?
In a nationwide real-world cohort, DOACs were associated with a significant early and sustained mortality benefit compared to VKAs in patients with nonvalvular atrial fibrillation.
PURPOSE: Limited real-world data are available on the survival of patients treated with vitamin K antagonists (VKAs) versus with direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (AF). In this nationwide registry, we analyzed the mortality risk of patients with nonvalvular AF taking DOACs versus VKAs, with a special attention to the early treatment period. METHODS: The Hungarian National Health Insurance Fund (NHIF) database was searched to identify patients treated with VKA or DOAC as a thromboembolic prophylaxis for nonvalvular AF between 2011 and 2016. The overall and the early (0-3, 4-6, and 7-12 months) mortality risks with the 2 types of anticoagulation were compared. A total of 144,394 patients with AF treated with either a VKA (n = 129,925) or a DOAC (n = 14,469) were enrolled. The RRR in mortality with DOACs was 33% within the first 3 months, and 6% in the second year. IMPLICATIONS: -VASc score, and those with fewer bleeding risk factors.
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Papp et al. (2023) conducted a cohort in nonvalvular atrial fibrillation (n=144,394). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on mortality (HR 0.50, 95% CI 0.34-0.73, p=0.001). DOACs were associated with a lower mortality risk compared to VKAs, including a 33% relative risk reduction within the first 3 months and an HR of 0.50 (95% CI 0.34-0.73) in low bleeding risk patients.
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