Key result
Dabigatran is linked to lower major bleeding than acenocoumarol with similar thromboembolism risk in AF.
Why the study?
Randomized trials showed non-inferior or superior results of NOACs compared with warfarin, motivating this evaluation of the effectiveness and safety of dabigatran versus acenocoumarol in patients with AF in daily clinical practice.
Does dabigatran reduce stroke or systemic embolism and major bleeding compared with acenocoumarol in real-world patients with atrial fibrillation?
Observational (n=766)
Single-blind outcome adjudication
No
Does dabigatran reduce stroke or systemic embolism and major bleeding compared with acenocoumarol in real-world patients with atrial fibrillation?
In real-world patients with atrial fibrillation, dabigatran demonstrated similar effectiveness for stroke prevention and a >50% reduction in major bleeding compared to the vitamin K antagonist acenocoumarol.
Answers are grounded in this paper and cite their sources.
May favor dabigatran for lower bleeding in real-world AF; extends RCT data but leaves open prospective confirmation.
AIMS: Randomized trials showed non-inferior or superior results of the non-vitamin-K-antagonist oral anticoagulants (NOACs) compared with warfarin. The aim of this study was to assess the effectiveness and safety of dabigatran (direct thrombin inhibitor) vs. acenocoumarol (vitamin K antagonist) in patients with atrial fibrillation (AF) in daily clinical practice. METHODS AND RESULTS: In this observational study, we evaluated all consecutive patients who started anticoagulation because of AF in our outpatient clinic from 2010 to 2013. Data were collected from electronic patient charts. Primary outcomes were stroke or systemic embolism and major bleeding. Propensity score matching was applied to address the non-randomized design. In total, 920 consecutive AF patients were enrolled (442 dabigatran, 478 acenocoumarol), of which 2 × 383 were available for analysis after propensity score matching. Mean follow-up duration was 1.5 ± 0.56 year. The mean calculated stroke risk according to the CHA2DS2-VASc score was 3.5%/year in dabigatran vs. 3.7%/year acenocoumarol-treated patients. The actual incidence rate of stroke or systemic embolism was 0.8%/year [95% confidence interval (CI): 0.2-2.1] vs. 1.0%/year (95% CI: 0.4-2.1), respectively. Multivariable analysis confirmed this lower but non-significant risk in dabigatran vs. acenocoumarol after adjustment for the CHA2DS2-VASc score [hazard ratio (HR)dabigatran = 0.72, 95% CI: 0.20-2.63, P = 0.61]. According to the HAS-BLED score, the mean calculated bleeding risk was 1.7%/year in both groups. Actual incidence rate of major bleeding was 2.1%/year (95% CI: 1.0-3.8) in the dabigatran vs. 4.3%/year (95% CI: 2.9-6.2) in acenocoumarol. This over 50% reduction remained significant after adjustment for the HAS-BLED score (HRdabigatran = 0.45, 95% CI: 0.22-0.93, P = 0.031). CONCLUSION: In 'real-world' patients with AF, dabigatran appears to be as effective, but significantly safer than acenocoumarol.
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Korenstra et al. (2016) conducted an observational in Non-valvular atrial fibrillation (n=766). Dabigatran vs. Acenocoumarol was evaluated on Stroke or systemic embolism (HR 0.72, 95% CI 0.20-2.63, p=0.61). Dabigatran showed similar stroke or systemic embolism risk and lower major bleeding risk compared with acenocoumarol in atrial fibrillation.
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