Abstract 11938: Long-term Population-based Outcomes of Novel Oral Anticoagulants Compared to Warfarin Among Long-term Anticoagulated Patients: A Propensity Matched Analysis

Abstract

Introduction: Novel oral anticoagulants (NOACs) have been used in clinical practice in the US for the last 4 years. While NOACs may be an attractive alternative to warfarin among many patients, long-term outcomes of use of these medications are unknown. We performed a propensity matched analysis of long-term outcomes among patients taking a NOAC or warfarin.

Hypothesis: NOACs will be superior to warfarin for the reduction of long-term outcomes.

Methods: Patients receiving long-term anticoagulation between June 2010 and December 2014 for thromboembolism prevention with either warfarin or a single NOAC were matched 1:1 by index date (± 6 months) and propensity score (±0.01). Multivariable Cox hazard regression was performed to determine the risk of death, stroke/TIA, major bleed, and bleed by the anticoagulant therapy received.

Results: Patients studied included: apixaban: 590, dabigatran: 583, rivaroxaban: 1, 454. A total of 5,254 patients were studied (2,627 per group). Average age was 72.4±10.9 and 59.0% were male. The majority of patients were receiving long-term anticoagulation for AF management (warfarin: 96.5% vs. NOAC: 92.7%, p<0.0001). Rivaroxaban (n=1,454 [55.3%]) was the most commonly used NOAC, (apixaban=590 [22.5%], dabigatran=583 [22.2%]). History of stroke/TIA and prior bleed were similar between the groups, yet more NOAC patients formally had major bleeding (9.2% vs. 6.8%, p=0.002). The use of NOACs compared to warfarin were associated with a reduced risk of long-term adverse outcomes [Figure, death (p=0.09), stroke/TIA (p<0.0001), major bleed (p<0.0001), and bleed (p=0.14)]. No significant outcome variance was noted in NOAC type comparison.

Conclusions: Our community-based results are support better long-term efficacy and safety of NOACs compared to warfarin, and are in agreement with the shorter-term results of previous clinical trials.