Abstract 13987: Comparative Effectiveness and Clinical Safety Between Dabigatran, Rivaroxaban, and Warfarin
Background: Several new oral anticoagulants have been developed for prevention of stroke/systemic embolism in atrial fibrillation (AF) patients. This retrospective cohort study aimed to provide real world data concerning the comparative effectiveness and clinical safety between dabigatran, rivaroxaban, and warfarin.
Methods: Incident adult users of oral anticoagulants with a diagnosis of AF at prescription were extracted from the National Health Insurance claims database in Taiwan from between Jun. 1 2012 and Dec. 31 2013. Two propensity scores were derived using multinomial logistic regression to model the probability of receipt of three study medications as a function of baseline characteristics. The proportional hazards models with adjustment of the quintiles of the propensity scores were used to estimate the relative hazards of specific outcomes between study groups.
Results: Totally, 16930 subjects including 4280 with dabigatran, 1499 with rivaroxaban, and 11151 with warfarin were identified. The mean age was 72.7 years and the median follow-up duration 8.7 months. Both dabigatran group (adjusted hazard ratio [aHR] 0.37, 95% confidence interval [CI] 0.30-0.46) and rivaroxaban group (aHR 0.50, 95% CI 0.37-0.66) possessed a lower risk of all-cause death in comparison with warfarin group. Comparing with warfarin group, dabigatran group and rivaroxaban group were also associated with lower risks of ischemic stroke (aHR 0.48, 95% CI 0.39-0.59 for dabigatran and aHR 0.50, 95% CI 0.36-0.69 for rivaroxaban), arterial embolism/thrombosis (aHR 0.42, 95% CI 0.26-0.68 for dabigatran and aHR 0.38, 95% CI 0.18-0.83 for rivaroxaban), and intracranial hemorrhage (aHR 0.29, 95% CI 0.16-0.51 for dabigatran and aHR 0.48, 95% CI 0.25-0.95 for rivaroxaban). In addition, we found no statistically significant difference between dabigatran and rivaroxaban in the risks of all the clinical outcomes studied.
Conclusions: Both dabigatran and rivaroxaban were associated with significant reductions in risks of all-cause death, ischemic stroke, arterial embolism/thrombosis, and intracranial hemorrhage, compared with warfarin. Besides, no significant difference could be found in the risks of various clinical outcomes between dabigatran and rivaroxaban.
Author Disclosures: C. Lai: None. H. Chen: None. T. Lin: None. M. Liao: None. K. Chan: None.
- © 2016 by American Heart Association, Inc.