Author + information
- Lingyun Lua,b,
- Alberta Warnera,b,
- Zunera Ghaznavia,b,
- Donald Changa,b,
- Nikolas Tuberta,b and
- Cynthia Jackeviciusa,b
Background: The comparative safety of direct oral anticoagulants (DOACs- dabigatran, rivaroxaban and apixaban) with warfarin is an important issue in patients with concomitant atrial fibrillation (AF) and heart failure (HF) that has not been examined in real-world practice.
Methods: We conducted a retrospective cohort study of veterans with AF and HF who were new users initiating DOACs or warfarin between October 1, 2010 and September 30, 2015. Patients were followed from the index date until switch/discontinuation of anticoagulants, death, or a maximum of 1 year. A multivariate Cox proportional hazards model was used to estimate the primary outcome of major and clinically relevant non-major bleeding.
Results: Among the new users (mainly elderly male patients) of 31,848 for warfarin, 3,382 for dabigatran, 1,821 for rivaroxaban, and 1,522 for apixaban, 1-year bleeding rates were 23.1%, 13.8%, 18.8%, and 13.6%, respectively. The adjusted hazards ratios (95% CI, P value) comparing each DOAC with warfarin for the primary outcome were as follows: dabigatran: 0.67 (0.58-0.77, P<0.0001); rivaroxaban: 0.87 (0.74-1.02, P=0.09); apixaban: 0.58 (0.48-0.71, P<0.0001).
Conclusions: Compared with warfarin, dabigatran and apixaban, but not rivaroxaban, were associated with a significantly lower risk of major and clinically relevant non-major bleeding. Dabigatran and apixaban may be safer choices for anticoagulation in patients with concomitant AF and HF.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-287
- 2017 American College of Cardiology Foundation