Author + information
- Ghanshyam Palamaner Subash Shantha,
- Prashant Bhave,
- Saket Girotra,
- Denice Hodgson-Zingman,
- Alexander Mazur,
- Michael Giudici,
- Elizabeth Chrischilles and
- Mary Vaughan-Sarrazin
Background: Direct oral anticoagulants (DOAC) are effective for stroke prevention among patients with non-valvular atrial fibrillation (AF). However, data assessing gender specific comparative effectiveness, of DOACs is lacking in the literature. In this retrospective cohort study we have assessed the gender specific, comparative effectiveness of DOACs [Rivaroxaban (RIVA) and Dabigatran (DABI)], compared to each other and to warfarin among patients with newly diagnosed AF.
Methods: Elderly (age >=66 years) Medicare beneficiaries enrolled in Medicare Part D benefit plan from November 2011 to October 2013 across the United States, with newly diagnosed AF, and were initiated on oral anticoagulants (RIVA: 20 mg daily, DABI: 150 mg two times a day or warfarin) for stroke prevention within 90 days of AF diagnosis formed the study cohort. Primary outcomes of inpatient admissions for strokes, and major bleeding were compared across the three drugs using three-way propensity matched samples. Outcomes were evaluated separately for men and women.
Results: 65,734 (44.8%) men and 81,137 (55.2%) women formed our study cohort. Among men: 637 (0.97%) strokes, and 1,901 (2.9%) major bleeding events were noted. Among women: 1090 (1.34%) strokes, and 2,574 (3.2%) major bleeding events were noted. In propensity-matched samples for men, RIVA use decreased stroke risk when compared to warfarin use (HR: 0.69, 95% CI: 0.48 – 0.99, P = 0.048) and DABI use (HR: 0.66, 95% CI: 0.45 – 0.95, P = 0.025), and was associated with a similar risk of any major bleeding when compared to Warfarin and DABI. In women, though stroke risk was similar in the 3 anticoagulant groups, RIVA use significantly increased the risk for any major bleeding when compared with warfarin (HR: 1.20, 95% CI: 1.03 – 1.42, P = 0.020) and DABI (HR: 1.25, 95% CI: 1.06 – 1.46, P = 0.007).
Conclusions: RIVA use was associated with a reduced stroke risk compared to DABI and warfarin in men with AF. In women, the 3 anticoagulants performed similar with stroke prevention, while RIVA use increased risk of bleeding. The higher risk of bleeding associated with RIVA noted in prior studies appears to be limited to women.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovative Approaches for Reducing Risk and Improving Outcomes With Ablation
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1237-095
- 2017 American College of Cardiology Foundation