Author + information
- Feng Wanga,b,
- Tatsunori Murataa,b,
- Naoko Izumia,b,
- Makoto Kidaa,b,
- Ruslan Horblyuka,b and
- Yasuo Terayamaa,b
Background: Evidence is scarce on how novel oral anticoagulants (NOACs), such as apixaban, dabigatran and rivaroxaban, perform vs. warfarin in ‘real-world’ settings in Japan. We aimed to compare the risk of bleeding events among non-valvular atrial fibrillation (NVAF) patients initiating a NOAC vs. warfarin using Japanese claims data.
Methods: A retrospective cohort study was conducted using de-identified records (3/1/ 2011 to 3/31/2016) from 247 institutions provided by the Medical Data Vision. Adult NVAF patients newly initiated on oral anticoagulants (OAC) were eligible. Based on the first (index) OAC prescription, patients were assigned to apixaban, dabigatran, rivaroxaban or warfarin group, and 1:1 propensity score matching (PSM) was used to balance patient characteristics between warfarin and each NOAC. Major bleeding (defined as bleeding requiring hospitalization) and any bleeding (defined as bleeding record) were compared between the 2 groups using Cox proportional hazards models. Patients were followed until either occurrence of bleeding event, discontinuation/switching of OAC, withdrawal from the database, or 365 days post index date.
Results: In total, 38,662 NVAF patients were eligible for analysis. After 1:1 PSM, there were 5,977 warfarin-apixaban matched patients, 5,090 warfarin-dabigatran matched patients and 6,726 warfarin-rivaroxaban matched patients. As compared to patients on warfarin, apixaban (hazard ratio (HR) =0.586; 95% CI: 0.421-0.815), dabigatran (HR=0.617; 95% CI; 0.425-0.895) and rivaroxaban (HR=0.693; 95% CI; 0.514-0.933) were associated with a significantly lower risk of major bleeding. The risk of any bleeding was significantly lower for apixaban vs. warfarin (HR=0.782; 95% CI; 0.682-0.896), and no differences were detected between dabigatran (HR=0.988; 95% CI; 0.860-1.135) or rivaroxaban (HR=0.938; 95% CI; 0.832-1.057) and warfarin.
Conclusions: Among NVAF patients in Japan, apixaban was associated with significantly lower risk of major bleeding as well as any bleeding when compared to warfarin. Dabigatran and rivaroxaban were associated with a significantly lower risk of major bleeding, but not any bleeding compared to warfarin.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Anticoagulation Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1189-090
- 2017 American College of Cardiology Foundation