Comparative effectiveness of rivaroxaban versus warfarin or dabigatran for the treatment of patients with non-valvular atrial fibrillation

Faye L. Norby, Lindsay G.S. Bengtson, Pamela L. Lutsey, Lin Y. Chen, Richard F. MacLehose, Alanna Chamberlain, Ian Rapson, Alvaro Alonso

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Rivaroxaban is an oral anticoagulant approved in the US for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). We determined the effectiveness and associated risks of rivaroxaban versus other oral anticoagulants in a large real-world population. Methods: We selected NVAF patients initiating oral anticoagulant use in 2010-2014 enrolled in MarketScan databases. Rivaroxaban users were matched with warfarin and dabigatran users by age, sex, enrolment date, anticoagulant initiation date, and high-dimensional propensity score. Study endpoints, including ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding, were identified from inpatient diagnostic codes. Multivariable Cox models were used to assess associations between type of anticoagulant and outcomes. Results: The analysis included 44,340 rivaroxaban users matched to 89,400 warfarin and 16,957 dabigatran users (38% female, mean age 70) with 12months of mean follow-up. Anticoagulant-naïve rivaroxaban initiators, but not those switching from warfarin, had lower risk of ischemic stroke [hazard ratio (HR) (95% confidence interval (CI)): 0.75 (0.62, 0.91)] and ICB [HR (95%CI): 0.55, (0.39, 0.78)] than warfarin users. In contrast, anticoagulant-experienced rivaroxaban initiators had higher risk of GI bleeding than warfarin users [HR (95%CI): 1.55 (1.32, 1.83)]. Endpoint rates were similar when comparing anticoagulant-naïve rivaroxaban and dabigatran initiators, with the exception of higher GI bleeding risk in rivaroxaban users [HR (95%CI) 1.28 (1.06, 1.54)]. There were no significant differences in the risk of MI among the comparison groups. Conclusion: In this large real-world sample of NVAF patients, effectiveness and risks of rivaroxaban versus warfarin differed by prior anticoagulant status, while effectiveness of rivaroxaban versus dabigatran differed in GI bleeding risk.

Original languageEnglish (US)
Article number238
JournalBMC Cardiovascular Disorders
Volume17
Issue number1
DOIs
StatePublished - Sep 6 2017

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Warfarin
Atrial Fibrillation
Anticoagulants
Hemorrhage
Confidence Intervals
Therapeutics
Stroke
Myocardial Infarction
Dabigatran
Rivaroxaban
Propensity Score
Embolism
Proportional Hazards Models
Inpatients
Databases

Keywords

  • Dabigatran
  • Non-valvular atrial fibrillation
  • Rivaroxaban
  • Stroke
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparative effectiveness of rivaroxaban versus warfarin or dabigatran for the treatment of patients with non-valvular atrial fibrillation. / Norby, Faye L.; Bengtson, Lindsay G.S.; Lutsey, Pamela L.; Chen, Lin Y.; MacLehose, Richard F.; Chamberlain, Alanna; Rapson, Ian; Alonso, Alvaro.

In: BMC Cardiovascular Disorders, Vol. 17, No. 1, 238, 06.09.2017.

Research output: Contribution to journalArticle

Norby, Faye L. ; Bengtson, Lindsay G.S. ; Lutsey, Pamela L. ; Chen, Lin Y. ; MacLehose, Richard F. ; Chamberlain, Alanna ; Rapson, Ian ; Alonso, Alvaro. / Comparative effectiveness of rivaroxaban versus warfarin or dabigatran for the treatment of patients with non-valvular atrial fibrillation. In: BMC Cardiovascular Disorders. 2017 ; Vol. 17, No. 1.
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AU - Bengtson, Lindsay G.S.

AU - Lutsey, Pamela L.

AU - Chen, Lin Y.

AU - MacLehose, Richard F.

AU - Chamberlain, Alanna

AU - Rapson, Ian

AU - Alonso, Alvaro

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N2 - Background: Rivaroxaban is an oral anticoagulant approved in the US for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). We determined the effectiveness and associated risks of rivaroxaban versus other oral anticoagulants in a large real-world population. Methods: We selected NVAF patients initiating oral anticoagulant use in 2010-2014 enrolled in MarketScan databases. Rivaroxaban users were matched with warfarin and dabigatran users by age, sex, enrolment date, anticoagulant initiation date, and high-dimensional propensity score. Study endpoints, including ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding, were identified from inpatient diagnostic codes. Multivariable Cox models were used to assess associations between type of anticoagulant and outcomes. Results: The analysis included 44,340 rivaroxaban users matched to 89,400 warfarin and 16,957 dabigatran users (38% female, mean age 70) with 12months of mean follow-up. Anticoagulant-naïve rivaroxaban initiators, but not those switching from warfarin, had lower risk of ischemic stroke [hazard ratio (HR) (95% confidence interval (CI)): 0.75 (0.62, 0.91)] and ICB [HR (95%CI): 0.55, (0.39, 0.78)] than warfarin users. In contrast, anticoagulant-experienced rivaroxaban initiators had higher risk of GI bleeding than warfarin users [HR (95%CI): 1.55 (1.32, 1.83)]. Endpoint rates were similar when comparing anticoagulant-naïve rivaroxaban and dabigatran initiators, with the exception of higher GI bleeding risk in rivaroxaban users [HR (95%CI) 1.28 (1.06, 1.54)]. There were no significant differences in the risk of MI among the comparison groups. Conclusion: In this large real-world sample of NVAF patients, effectiveness and risks of rivaroxaban versus warfarin differed by prior anticoagulant status, while effectiveness of rivaroxaban versus dabigatran differed in GI bleeding risk.

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