Comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in atrial fibrillation: a nationwide cohort study

Abstract

Aims The aim of this study was to compare the risk of stroke or systemic embolism (SE) and major bleeding in patients with atrial fibrillation (AF) using dabigatran, rivaroxaban, and apixaban in routine clinical practice. Methods and results Using nationwide registries in Norway from January 2013 to December 2017, we established a cohort of 52 476 new users of non-vitamin K antagonist oral anticoagulants (NOACs) with AF. Users of individual NOACs were matched 1:1 on the propensity score to create three pairwise-matched cohorts: dabigatran vs. rivaroxaban (20 504 patients), dabigatran vs. apixaban (20 826 patients), and rivaroxaban vs. apixaban (27 398 patients). Hazard ratios (HRs) for the risk of stroke or SE and major bleeding were estimated. In the propensity-matched comparisons of the risk of stroke or SE, the HRs were 0.88 [95% confidence interval (CI) 0.76–1.02] for dabigatran vs. rivaroxaban, 0.88 (95% CI 0.75–1.02) for dabigatran vs. apixaban, and 1.00 (95% CI 0.89–1.14) for apixaban vs. rivaroxaban. For the risk of major bleeding, the HRs were 0.75 (95% CI 0.64–0.88) for dabigatran vs. rivaroxaban, 1.03 (95% CI 0.85–1.24) for dabigatran vs. apixaban, and 0.79 (95% CI 0.68–0.91) for apixaban vs. rivaroxaban. Conclusion In this nationwide study of patients with AF in Norway, we found no statistically significant differences in risk of stroke or SE in propensity-matched comparisons between dabigatran, rivaroxaban, and apixaban. However, dabigatran and apixaban were both associated with significantly lower risk of major bleeding compared with rivaroxaban.

Trends in the Prescription of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation: Results of the Polish Atrial Fibrillation (POL-AF) Registry

“…This study showed an increase in apixaban use since its introduction and a decline in dabigatran use [18]. The highest proportion of patients treated with apixaban was also declared in The Norwegian Patient Registry [19]. In the present study, a reduced NOAC dose was most often administered to patients treated with dabigatran, just as in the Norwegian Patient Registry [20].…”

“…The same results were obtained in the study by Maura et al [25] with a group of 127,841 patients with AF who were administered NOACs. In the Norwegian Patient Registry [19], patients taking apixaban had the highest CHA 2 DS 2 -VASc scores, whereas the highest HAS-BLED scores were reported in patients receiving rivaroxaban.…”

“…In the present study, previous bleeding was a predisposing factor for use of apixaban, which reduced the chance of using rivaroxaban. In a nationwide study of patients with AF in Norway, it was found that dabigatran and apixaban were both associated with a significantly lower risk of major bleeding compared with rivaroxaban [19]. The data from the Danish nationwide registry showed that rivaroxaban was associated with a higher risk of major bleeding compared with apixaban [31].…”

Direct Oral Anticoagulants after Ischemic Stroke: Which Patient? Which Drug? And How Early?

“…One of the latest studies included 52,476 patients with AF from nationwide registries in Norway and compared dabigatran, rivaroxaban, and apixaban over a median follow-up of 18 months. 23 Overall, the risk of stroke or SE was similar across the DOACs in the propensity score analysis, while the risk of major bleeding was significantly lower for dabigatran and apixaban compared with rivaroxaban. Of interest, in the subgroup with a history of stroke (13% of the overall cohort), rivaroxaban was superior to both apixaban and dabigatran in preventing recurrent strokes, with a similar bleeding rate.…”

Evidence-based approaches to comparing the effectiveness of modern cardiology interventions: trends, bias and prospects

“…Например, результаты анализа, выполненного Jonasson C, et al [32] с использованием метода PS, в который были включены данные о более чем 52 тыс. пациентов с ФП, свидетельствовали о менее высоком риске развития кровотечений при применении апиксабана и дабигатрана по сравнению с ривароксабаном.…”