Author + information
- Alpesh Amina,b,
- Allison Keshishiana,b,
- Jeffrey Trocioa,b,
- Hannah Lea,b,
- Oluwaseyi Dinaa,b,
- Qisu Zhanga,b,
- Onur Basera,b and
- Lien Voa,b
Background: Clinical trials have shown direct oral anticoagulants (DOACs) are at least as effective and safe as warfarin for risk of stroke/systemic embolism (S/SE) and major bleeding (MB) compared to warfarin. This study compared risk of S/SE and MB among non-valvular atrial fibrillation (NVAF) patients initiating oral anticoagulants in the US Medicare population.
Methods: NVAF patients ≥65 years in the US Medicare database; recently prescribed apixaban, rivaroxaban, dabigatran or warfarin were selected from 01JAN2013-31DEC2014. 1:1 propensity score matching was used to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate the hazard ratio (HR) of S/SE and MB (using primary ICD-9 codes of inpatient claims).
Results: The matched cohorts, followed for a mean of 5-6 months, were balanced with mean age of 77-78 years and CHA2DS2-VASc score of 4.4-4.7. Apixaban and rivaroxaban initiators had a lower risk of S/SE, while dabigatran showed similar risk of S/SE compared to warfarin. Apixaban and dabigatran initiators had significantly lower risk of MB, while rivaroxaban showed higher risk of MB compared to warfarin.
Conclusions: This study included NVAF patients in the US Medicare population with higher risk of S/SE and MB than those in Phase III clinical trials. Apixaban showed lower risks of S/SE and MB, dabigatran showed similar risk of S/SE but lower risk of MB, and rivaroxaban showed lower risk of S/SE but higher risk of MB in comparison to warfarin.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:15 a.m.-11:25 a.m.
Session Title: Atrial Fibrillation, Anticoagulation and Novel Device Therapies
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1134M-13
- 2017 American College of Cardiology Foundation