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Comparative effectiveness of oral anticoagulants in everyday practice
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Camm, A John, Fox, Keith A A, Virdone, Saverio, Bassand, Jean-Pierre, Fitzmaurice, David, Berchuck, Samuel I, Gersh, Bernard J, Goldhaber, Samuel Z., Goto, Shinya, Haas, Sylvia, Misselwitz, Frank, Pieper, Karen S., Turpie, Alexander G G, Verheugt, Freek W A, Cappato, Riccardo and Kakkar, Ajay K. (2021) Comparative effectiveness of oral anticoagulants in everyday practice. Heart, 107 (12). pp. 962-970. doi:10.1136/heartjnl-2020-318420
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Official URL: http://dx.doi.org/10.1136/heartjnl-2020-318420
Abstract
Objectives: This study evaluated the comparative effectiveness of vitamin K antagonists (VKAs), direct thrombin inhibitors (DTIs) and factor Xa inhibitors (FXaI) in patients with atrial fibrillation (AF) at risk of stroke in everyday practice.
Methods: Data from patients with AF and Congestive heart failure, Hypertension, Age 75 years, Diabetes mellitus, prior Stroke, TIA, or thromboembolism, Vascular disease, Age 65-74 years, Sex category (CHA2DS2-VASc) score ≥2 (excluding gender) in the Global Anticoagulant Registry in the FIELD–Atrial Fibrillation registry were analysed using an improved method of propensity weighting, overlap weights and Cox proportional hazards models.
Results: All-cause mortality, non-haemorrhagic stroke/systemic embolism (SE) and major bleeding over 2 years were compared in 25 551 patients, 7162 (28.0%) not treated with oral anticoagulant (OAC) and 18 389 (72.0%) treated with OAC (FXaI (41.8%), DTI (11.4%) and VKA (46.8%)). OAC treatment compared with no OAC treatment was associated with decreased risk of all-cause mortality (HR 0.82 (95% CI 0.74 to 0.91)) and non-haemorrhagic stroke/SE (HR 0.71 (95% CI 0.57 to 0.88)) but increased risk of major bleeding (HR 1.46 (95% CI 1.15 to 1.86)). Non-vitamin K antagonist oral anticoagulant (NOAC) use compared with no OAC treatment was associated with lower risks of all-cause mortality and non-haemorrhagic stroke/SE (HR 0.67 (95% CI 0.59 to 0.77)) and 0.65 (95% CI 0.50 to 0.86)) respectively, with no increase in major bleeding (HR 1.10 (95% CI 0.82 to 1.47)). NOAC use compared with VKA use was associated with lower risk of all-cause mortality and major bleeding (rates/100 patient-years 3.6 (95% CI 3.3 to 3.9) vs 4.8 (95% CI 4.5 to 5.2) and 1.0 (95% CI 0.9 to 1.1) vs 1.4 (95% CI 1.2 to 1.6); HR 0.79 (95% CI 0.70 to 0.89) and 0.77 (95% CI 0.61 to 0.98) respectively), with similar risk of non-haemorrhagic stroke/SE (rates/100 patient-years 0.8 (95% CI 0.7 to 0.9) versus 1.0 (95% CI 0.8 to 1.1); HR 0.96 (95% CI 0.73 to 1.25).
Conclusion: Important benefits in terms of mortality and major bleeding were observed with NOAC versus VKA with no difference among NOAC subtypes.
| Item Type: | Journal Article | |||||||||
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| Subjects: | Q Science > QP Physiology R Medicine > RA Public aspects of medicine R Medicine > RB Pathology R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | |||||||||
| SWORD Depositor: | Library Publications Router | |||||||||
| Library of Congress Subject Headings (LCSH): | Anticoagulants (Medicine) , Oral medication , Vitamin K , Arrhythmia, Arrhythmia -- Treatment, Sudden death , Atrial fibrillation , Cerebrovascular disease , Cerebrovascular disease -- Prevention | |||||||||
| Journal or Publication Title: | Heart | |||||||||
| Publisher: | BMJ Publishing Group | |||||||||
| ISSN: | 1468-201X | |||||||||
| Official Date: | May 2021 | |||||||||
| Dates: |
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| Volume: | 107 | |||||||||
| Number: | 12 | |||||||||
| Page Range: | pp. 962-970 | |||||||||
| DOI: | 10.1136/heartjnl-2020-318420 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access | |||||||||
| RIOXX Funder/Project Grant: |
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