Comparison of Characteristics and Outcomes of Dabigatran Versus Warfarin in Hypertensive Patients With Atrial Fibrillation (from the RE-LY Trial)

Nagarakanti, Rangadham; Wallentin, Lars; Noack, Herbert; Brueckmann, Martina; Reilly, Paul; Clemens, Andreas; Connolly, Stuart J.; Yusuf, Salim; Ezekowitz, Michael D.

doi:10.1016/j.amjcard.2015.07.032

Cited by 58 publications

(31 citation statements)

References 18 publications

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“…In the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy), there was no significant difference in vascular and all-cause death between patients with or without hypertension. 16 In the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) cohort, a diagnosis of hypertension was associated with lower risk of all-cause death (HR, 0.73; 95% CI, 0.61-0.88) and a nonsignificant trend toward lower cardiovascular mortality (HR, 0.81; 95% CI, 0.63-1.05). 17 In the ROCKET AF trial (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation), lower screening SBP was associated with a higher risk of vascular death (HR, 0.95; 95% CI, 0.90-0.99).…”

Section: Implications Of Low Bp Targets In Afmentioning

confidence: 99%

“…No impact of hypertension history on stroke and systemic embolism outcomes was observed, perhaps explained by a higher prevalence of stage I hypertension and high-quality BP control during the trial follow-up period. 16 When BP was analyzed as a continuous variable, increasing SBP and mean BP were associated with higher risk of stroke observed with every 10 mm Hg BP increase. 16 Similarly, in an ancillary study from the ROCKET AF trial (rivaroxaban versus warfarin), the risk of stroke or systemic embolism increased by 7% for every 10 mm Hg increase in screening SBP.…”

Section: Balancing Stroke and Bleeding Risk In Hypertension And Afmentioning

confidence: 99%

“…16 When BP was analyzed as a continuous variable, increasing SBP and mean BP were associated with higher risk of stroke observed with every 10 mm Hg BP increase. 16 Similarly, in an ancillary study from the ROCKET AF trial (rivaroxaban versus warfarin), the risk of stroke or systemic embolism increased by 7% for every 10 mm Hg increase in screening SBP. 2,18 The ARISTOTLE trial (apixaban versus warfarin) also confirmed the importance of good BP control in AF.…”

Section: Balancing Stroke and Bleeding Risk In Hypertension And Afmentioning

confidence: 99%

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Atrial Fibrillation and Hypertension

et al. 2017

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Section: Implications Of Low Bp Targets In Afmentioning

confidence: 99%

Section: Balancing Stroke and Bleeding Risk In Hypertension And Afmentioning

confidence: 99%

Section: Balancing Stroke and Bleeding Risk In Hypertension And Afmentioning

confidence: 99%

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Atrial Fibrillation and Hypertension

et al. 2017

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“…Another sub-study from the RE-LY trial showed a higher dose of dabigatran (150 mg) to be associated with significantly fewer strokes while 110 mg dabigatran was associated with a significantly lower rate of major bleeding. But however, these dose regimens were compared to warfarin [15]. …”

Section: Discussionmentioning

confidence: 99%

Bleeding events associated with a low dose (110 mg) versus a high dose (150 mg) of dabigatran in patients treated for atrial fibrillation: a systematic review and meta-analysis

Bundhun

Chaudhary

2017

BMC Cardiovasc Disord

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BackgroundThe newer oral anticoagulant dabigatran is considered to be more beneficial in patients with non-valvular Atrial Fibrillation (AF) when compared to warfarin. However, because bleeding events which are associated with a low dose (110 mg) versus a high dose (150 mg) of dabigatran have seldom been compared, we aimed to systematically solve this important issue through this meta-analysis.MethodsEnglish publications comparing 110 mg with 150 mg dabigatran in patients who were treated for AF were electronically searched through medical databases. Bleeding outcomes were the major clinical endpoints to be assessed. Odds Ratios (OR) and 95% Confidence Intervals (CIs) for each subgroup were calculated and the main analysis was carried out by the latest version of the RevMan 5.3 software.ResultsTwenty-nine thousand two hundred and sixty-four (29,264) patients were included in this meta-analysis. Fifteen thousand eight hundred and forty-eight (15,848) patients were treated with 110 mg dabigatran whereas 13,416 patients were treated with 150 mg dabigatran. 110 mg dabigatran was associated with a significantly lower rate of minor bleeding (OR: 1.19, 95% CI: 1.10–1.27; P < 0.00001). A similar rate of fatal and major bleeding was observed with both dosages (OR: 1.12, 95% CI: 0.69–1.82; P = 0.65) and (OR: 1.09, 95% CI: 0.86–1.37; P = 0.49) respectively. However, ischemic stroke insignificantly favored a higher dose of dabigatran, (OR: 0.77, 95% CI: 0.51–1.16; P = 0.21). In addition, this analysis showed mortality to significantly favor 150 mg of dabigatran (OR: 0.41, 95% CI: 0.34–0.50; P < 0.00001).ConclusionNo significant differences in major and fatal bleedings were observed with 110 mg versus 150 mg dabigatran. However, 110 mg dabigatran was associated with a significantly lower risk of minor bleeding. These results should further be confirmed in future trials.

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“…Non-vitamin K oral anticoagulants (NOAC) are a feasible, effective treatment option in hypertensive AF patients, characterised by similar efficacy as in normotensive patients [19]. Nevertheless, some AF patients require vitamin K antagonists (VKA).…”

Section: Dihydropyridine Calcium Antagonists Nonementioning

confidence: 99%