Initiation of apixaban (HR 0.53; 95% CI 0.39-0.71) or dabigatran (HR 0.69; 95% CI 0.50-0.96) was associated with a significantly lower risk of major bleeding compared to warfarin in NVAF patients.
Cohort (n=45,361)
Do NOACs (apixaban, dabigatran, rivaroxaban) reduce major bleeding compared to warfarin in newly anticoagulated NVAF patients?
In a real-world setting of newly anticoagulated NVAF patients, apixaban and dabigatran were associated with a significantly lower risk of major bleeding compared to warfarin, whereas rivaroxaban was not.
Hazard Ratio: 0.53 (95% CI 0.39–0.71)
Summary In addition to warfarin, there are four non-vitamin K antagonist oral anticoagulants (NOACs) available for stroke prevention in non valvular atrial fibrillation (NVAF). There are limited data on the comparative risks of major bleeding among newly anticoagulated NVAF patients who initiate warfarin, apixaban, dabigatran, or rivaroxaban, when used in ‘real world’ clinical practice. The study used the Truven MarketScan® Commercial 95 % CI: 0.39–0.71) and dabigatran (HR: 0.69; 95 % CI: 0.50–0.96) initiators had a significantly lower risk of major bleeding. Patients initiating rivaroxaban (HR: 0.98; 95 % CI: 0.83–1.17) had a non-significant difference in major bleeding risk compared to matched warfarin patients. When comparisons were made between NOACs, matched rivaroxaban patients had a significantly higher risk of major bleeding (HR: 1.82; 95 % CI: 1.36–2.43) compared to apixaban patients. The differences for apixaban-dabigatran and dabigatran-rivaroxaban matched cohorts were not statistically significant. Among newly anticoagulated NVAF patients in the real-world setting, apixaban and dabigatran initiation was associated with significantly lower risk of major bleeding compared to warfarin initiation. When compared to apixaban, rivaroxaban initiation was associated with significantly higher risk of major bleeding. Note: The review process for this paper was fully handled by Christian Weber, Editor in Chief. Supplementary Material to this article is available online at www.thrombosis-online.com.
Keshishian et al. (2016) conducted a cohort in Non-valvular atrial fibrillation (NVAF) (n=45,361). Apixaban vs. Warfarin was evaluated on Major bleeding requiring hospitalisation (HR 0.53, 95% CI 0.39-0.71). Initiation of apixaban (HR 0.53; 95% CI 0.39-0.71) or dabigatran (HR 0.69; 95% CI 0.50-0.96) was associated with a significantly lower risk of major bleeding compared to warfarin in NVAF patients.