Author + information
- Received February 21, 2018
- Revision received March 11, 2018
- Accepted April 3, 2018
- Published online June 25, 2018.
- Christina Ji-Young Lee, MDa,b,∗ (, )@uni_copenhagen,
- Thomas Alexander Gerds, PhDc,d,
- Nicholas Carlson, MD, PhDe,d,
- Anders Nissen Bonde, MDb,
- Gunnar Hilmar Gislason, MD, PhDb,d,
- Morten Lamberts, MD, PhDf,
- Jonas Bjerring Olesen, MD, PhDb,
- Jannik Langtved Pallisgaard, MD, PhDb,
- Morten Lock Hansen, MD, PhDb and
- Christian Torp-Pedersen, MD, DMSca
- aDepartment of Health Science and Technology, Aalborg University and Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- bDepartment of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
- cDepartment of Biostatistics, Copenhagen University, Copenhagen, Denmark
- dThe Danish Heart Foundation, Copenhagen, Denmark
- eDepartment of Internal Medicine, Holbaek Hospital, Copenhagen, Denmark
- fThe Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Christina Ji-Young Lee, Department of Health Science and Technology (Institut for Medicin og Sundhedsteknologi), Aalborg University, Fredrik Bajers Vej 7 D2, DK-9220 Aalborg East, Denmark.
Background Evidence is conflicting as to the efficacy of direct oral anticoagulation (DOAC) and vitamin K antagonist (VKA) for prevention of myocardial infarction (MI).
Objectives This study aimed to investigate the risk of MI associated with the use of apixaban, dabigatran, rivaroxaban, and VKA in patients with atrial fibrillation.
Methods Patients with atrial fibrillation were identified using Danish health care registers and stratified by initial oral anticoagulant treatment. Standardized absolute 1-year risks were estimated based on Cox regression for hazard rates of MI hospitalizations and mortality. Reported were absolute risks separately for the oral anticoagulation treatments and standardized to the characteristics of the study population.
Results Of the 31,739 patients included (median age, 74 years; 47% females), the standardized 1-year risk of MI for VKA was 1.6% (95% confidence interval [CI]: 1.3 to 1.8), apixaban was 1.2% (95% CI: 0.9 to 1.4), dabigatran was 1.2% (95% CI: 1.0 to 1.5), and rivaroxaban was 1.1% (95% CI: 0.8 to 1.3). No significant risk differences were observed in the standardized 1-year risks of MI among the DOACs: dabigatran versus apixaban (0.04%; 95% CI: −0.3 to 0.4), rivaroxaban versus apixaban (0.1%; 95% CI: −0.4 to 0.3), and rivaroxaban versus dabigatran (−0.1%; 95% CI: −0.5 to 0.2). The risk differences for DOACs versus VKA were all significant: −0.4% (95% CI: −0.7 to −0.1) for apixaban, −0.4% (95% CI: −0.7 to −0.03) for dabigatran, and −0.5% (95% CI: −0.8 to −0.2) for rivaroxaban.
Conclusions No significant risk differences of MI were found in the direct comparisons of DOACs, and DOACs were all associated with a significant risk reduction of MI compared with VKA.
Supported by Aalborg University, Department of Health Science and Technology. Dr. Gislason has received research grants from Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, Bayer, and AstraZeneca. Dr. Lamberts has received speaker fees from Bristol-Myers Squibb and Bayer. Dr. Olesen has received speaker fees from Bristol-Myers Squibb, Boehringer Ingelheim, Bayer, and AstraZeneca; is a consultant for Bristol-Myers Squibb, Boehringer Ingelheim, and Novo Nordisk; has received funding for research from the Lundbeck Foundation, Bristol-Myers Squibb, and The Capital Region of Denmark, Foundation for Health Research; and is an advisory board member for Novo Nordisk. Dr. Hansen has received speaker fees from and is an advisory board member for Bristol-Myers Squibb, Boehringer Ingelheim, and Bayer; and has received research grants from Bristol-Myers Squibb. Dr. Torp-Pedersen has received research grants and speaker fees from Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 21, 2018.
- Revision received March 11, 2018.
- Accepted April 3, 2018.
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