1. Comparative Safety and Effectiveness of Reduced Doses of Direct Acting Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation.
- Author
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Skjøth F, Larsen TB, Dun AR, Lilja M, Rahman I, Abdelgawwad K, Halvorsen S, Coleman C, and Rivera M
- Subjects
- Humans, Aged, Male, Female, Factor Xa Inhibitors therapeutic use, Factor Xa Inhibitors administration & dosage, Factor Xa Inhibitors adverse effects, Anticoagulants administration & dosage, Anticoagulants therapeutic use, Anticoagulants adverse effects, Aged, 80 and over, Administration, Oral, Ischemic Stroke prevention & control, Ischemic Stroke epidemiology, Middle Aged, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Rivaroxaban therapeutic use, Rivaroxaban adverse effects, Rivaroxaban administration & dosage, Pyrazoles therapeutic use, Pyrazoles administration & dosage, Pyrazoles adverse effects, Pyridones administration & dosage, Pyridones therapeutic use, Pyridones adverse effects, Dabigatran therapeutic use, Dabigatran adverse effects, Dabigatran administration & dosage, Warfarin therapeutic use, Warfarin adverse effects, Warfarin administration & dosage, Stroke prevention & control, Stroke etiology, Stroke epidemiology
- Abstract
Background: This Nordic observational cohort study aims to assess the effectiveness and safety of reduced-dose direct-acting oral anticoagulants (DOACs) dabigatran, rivaroxaban, and apixaban compared to standard warfarin for stroke prevention in nonvalvular atrial fibrillation., Methods: The study, utilizing nationwide administrative databases from Denmark, Sweden, Norway, and Finland, spanned from January 1, 2011 to December 31, 2018 (2017 for Sweden). The cohort included 26,883 patients initiating reduced-dose DOACs and 108,014 comparable warfarin patients. Effectiveness was measured by the composite endpoint of ischemic stroke and systemic embolism, while safety was assessed through intracranial hemorrhage., Results: The meta-analysis across countries revealed similar or lower incidences of ischemic stroke and systemic embolism in patients on reduced-dose DOACs compared to standard warfarin (rivaroxaban: HR 0.93, dabigatran: HR 0.88, apixaban: HR 0.79). Incidences within warfarin groups ranged from 2.16 to 3.71 per 100 person-years, comparable to DOAC recipients. Intracranial hemorrhage rates were generally low, ranging from 0.16 to 1.85 per 100 person-years. In comparison with warfarin patients, meta-analyses yielded HRs for rivaroxaban (1.41), dabigatran (0.35), and apixaban (0.72)., Conclusions: In this study, atrial fibrillation patients initiating reduced-dose rivaroxaban and dabigatran exhibited incidences of ischemic stroke and systemic embolism similar to warfarin, and for apixaban, even lower. Rates of intracranial hemorrhage were comparable to or lower for patients on DOACs compared to warfarin., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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