Effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in atrial fibrillation: a Scandinavian population-based cohort study
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Effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in atrial fibrillation : a Scandinavian population-based cohort study. / Halvorsen, Sigrun; Johnsen, Søren P.; Madsen, Morten; Linder, Marie; Sulo, Gerhard; Ghanima, Waleed; Gislason, Gunnar; Hohnloser, Stefan H; Jenkins, Aaron; Al-Khalili, Faris; Tell, Grethe S; Ehrenstein, Vera.
I: European Heart Journal - Quality of Care and Clinical Outcomes, Bind 8, Nr. 5, 2022, s. 577-587.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in atrial fibrillation
T2 - a Scandinavian population-based cohort study
AU - Halvorsen, Sigrun
AU - Johnsen, Søren P.
AU - Madsen, Morten
AU - Linder, Marie
AU - Sulo, Gerhard
AU - Ghanima, Waleed
AU - Gislason, Gunnar
AU - Hohnloser, Stefan H
AU - Jenkins, Aaron
AU - Al-Khalili, Faris
AU - Tell, Grethe S
AU - Ehrenstein, Vera
PY - 2022
Y1 - 2022
N2 - Aims Using Scandinavian population-based registries, we assessed risk of stroke/systemic embolism (SE) and bleeding with non-vitamin K antagonist oral anticoagulants compared with warfarin in anticoagulation-naive patients with atrial fibrillation (AF). Methods and results This historical cohort study included 219 545 AF patients [median age 74 years; 43% women; mean CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75 years, diabetes mellitus, stroke or transient ischaemic attack, vascular disease, age 65-74 years, sex category) score 3.3] initiating apixaban, dabigatran, rivaroxaban, or warfarin in Denmark, Norway, and Sweden (1 January 2013 to 31 December 2016). The primary endpoints were stroke/SE and major bleeding. The median follow-up times were 9.7 (3.9-21.5) months for stroke/SE and 9.6 (3.8-21.3) months for bleeding. Apixaban and warfarin initiators were older and had higher CHA(2)DS(2)-VASc scores compared with dabigatran and rivaroxaban initiators. After 1:1 propensity score matching, three cohorts were created: apixaban-warfarin (n = 111 162), dabigatran-warfarin (n = 56 856), and rivaroxaban-warfarin (n = 61 198). Adjusted hazard ratios (HRs) were estimated using a Cox regression. For stroke/SE, adjusted HRs against warfarin were 0.96 [95% confidence interval (CI): 0.87-1.06] for apixaban, 0.89 (95% CI: 0.80-1.00) for dabigatran, and 1.03 (95% CI: 0.92-1.14) for rivaroxaban. For major bleeding, the HRs against warfarin were 0.73 (95% CI: 0.67-0.78) for apixaban, 0.89 (95% CI: 0.82-0.97) for dabigatran, and 1.15 (95% CI: 1.07-1.25) for rivaroxaban. The results in the dabigatran cohort did not hold in all dose-defined subgroups. Conclusion In this large Scandinavian study among AF patients initiating oral anticoagulation, those initiating dabigatran, apixaban, and rivaroxaban had similar rates of stroke/SE to patients initiating warfarin. Rates of major bleeding were lower with apixaban and dabigatran and higher with rivaroxaban, each compared with warfarin.
AB - Aims Using Scandinavian population-based registries, we assessed risk of stroke/systemic embolism (SE) and bleeding with non-vitamin K antagonist oral anticoagulants compared with warfarin in anticoagulation-naive patients with atrial fibrillation (AF). Methods and results This historical cohort study included 219 545 AF patients [median age 74 years; 43% women; mean CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75 years, diabetes mellitus, stroke or transient ischaemic attack, vascular disease, age 65-74 years, sex category) score 3.3] initiating apixaban, dabigatran, rivaroxaban, or warfarin in Denmark, Norway, and Sweden (1 January 2013 to 31 December 2016). The primary endpoints were stroke/SE and major bleeding. The median follow-up times were 9.7 (3.9-21.5) months for stroke/SE and 9.6 (3.8-21.3) months for bleeding. Apixaban and warfarin initiators were older and had higher CHA(2)DS(2)-VASc scores compared with dabigatran and rivaroxaban initiators. After 1:1 propensity score matching, three cohorts were created: apixaban-warfarin (n = 111 162), dabigatran-warfarin (n = 56 856), and rivaroxaban-warfarin (n = 61 198). Adjusted hazard ratios (HRs) were estimated using a Cox regression. For stroke/SE, adjusted HRs against warfarin were 0.96 [95% confidence interval (CI): 0.87-1.06] for apixaban, 0.89 (95% CI: 0.80-1.00) for dabigatran, and 1.03 (95% CI: 0.92-1.14) for rivaroxaban. For major bleeding, the HRs against warfarin were 0.73 (95% CI: 0.67-0.78) for apixaban, 0.89 (95% CI: 0.82-0.97) for dabigatran, and 1.15 (95% CI: 1.07-1.25) for rivaroxaban. The results in the dabigatran cohort did not hold in all dose-defined subgroups. Conclusion In this large Scandinavian study among AF patients initiating oral anticoagulation, those initiating dabigatran, apixaban, and rivaroxaban had similar rates of stroke/SE to patients initiating warfarin. Rates of major bleeding were lower with apixaban and dabigatran and higher with rivaroxaban, each compared with warfarin.
KW - Anticoagulants
KW - Atrial fibrillation
KW - Bleeding
KW - Cohort study
KW - Stroke
KW - PATIENT REGISTRY
KW - RIVAROXABAN
KW - VALIDATION
KW - DABIGATRAN
KW - MANAGEMENT
KW - APIXABAN
KW - EFFICACY
KW - QUALITY
KW - WORLD
U2 - 10.1093/ehjqcco/qcab048
DO - 10.1093/ehjqcco/qcab048
M3 - Journal article
C2 - 34244745
VL - 8
SP - 577
EP - 587
JO - European Heart Journal - Quality of Care and Clinical Outcomes
JF - European Heart Journal - Quality of Care and Clinical Outcomes
SN - 2058-5225
IS - 5
ER -
ID: 302827133