1. Dabigatran versus vitamin K antagonists for atrial fibrillation in clinical practice: final outcomes from Phase III of the GLORIA-AF registry
- Author
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Huisman, M.V., Teutsch, C., Lu, S.H., Diener, H.C., Dubner, S.J., Halperin, J.L., Ma, C.S., Rothman, K.J., Lohmann, R., Gurusamy, V.K., Bartels, D.B., Lip, G.Y.H., and GLORIA-AF Investigators
- Subjects
Vitamin K ,Medizin ,Myocardial Infarction ,Administration, Oral ,Anticoagulants ,Hemorrhage ,General Medicine ,Atrial fibrillation ,Dabigatran ,Stroke ,Anticoagulation ,Clinical Trials, Phase III as Topic ,Fibrinolytic Agents ,Stroke prevention ,Humans ,Prospective Studies ,Registries ,Vitamin K antagonist ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Background Prospectively collected, routine clinical practice-based data on antithrombotic therapy in non-valvular atrial fibrillation (AF) patients are important for assessing real-world comparative outcomes. The objective was to compare the safety and effectiveness of dabigatran versus vitamin K antagonists (VKAs) in patients with newly diagnosed AF. Methods and results GLORIA-AF is a large, prospective, global registry program. Consecutive patients with newly diagnosed AF and CHA2DS2-VASc scores ≥ 1 were included and followed for 3 years. To control for differences in patient characteristics, the comparative analysis for dabigatran versus VKA was performed on a propensity score (PS)-matched patient set. Missing data were multiply imputed. Proportional-hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Between 2014 and 2016, 21,300 eligible patients were included worldwide: 3839 patients were prescribed dabigatran and 4836 VKA with a median age of 71.0 and 72.0 years, respectively; > 85% in each group had a CHA2DS2-VASc-score ≥ 2. The PS-matched comparative analysis for dabigatran and VKA included on average 3326 pairs of matched initiators. For dabigatran versus VKAs, adjusted HRs (95% confidence intervals) were: stroke 0.89 (0.59–1.34), major bleeding 0.61 (0.42–0.88), all-cause death 0.78 (0.63–0.97), and myocardial infarction 0.89 (0.53–1.48). Further analyses stratified by PS and region provided similar results. Conclusions Dabigatran was associated with a 39% reduced risk of major bleeding and 22% reduced risk for all-cause death compared with VKA. Stroke and myocardial infarction risks were similar, confirming a more favorable benefit-risk profile for dabigatran compared with VKA in clinical practice. Clinical trial registrationhttps://www.clinicaltrials.gov. NCT01468701, NCT01671007. Graphical abstract
- Published
- 2022