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Comparison of the Safety and Effectiveness of Four Direct Oral Anticoagulants in Japanese Patients with Nonvalvular Atrial Fibrillation Using Real-World Data
- Source :
- Biological and Pharmaceutical Bulletin. 44:1294-1302
- Publication Year :
- 2021
- Publisher :
- Pharmaceutical Society of Japan, 2021.
-
Abstract
- Direct oral anticoagulants (DOACs) are widely used for the prevention of ischemic stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). However, the differences in safety and effectiveness among four DOACs, dabigatran, rivaroxaban, apixaban, and edoxaban, in Japanese patients have not been clarified. Therefore, we conducted a retrospective cohort study to directly compare the safety and effectiveness among the four DOACs using the Japan Medical Data Center (JMDC) claims database. We identified 3823 patients with NVAF who started receiving a DOAC between March 2011 and June 2017. The safety outcome was major bleeding (a composite outcome of intracranial, gastrointestinal, respiratory, or renal/urinary tract bleeding) and the effectiveness outcome was the composite of ischemic stroke including transient ischemic attack (TIA) or systemic embolism. We constructed a Cox proportional hazard model to calculate the hazard ratio (HR) for all four DOAC combinations. The risk of major bleeding was significantly lower in the dabigatran group than in the apixaban group (HR, 0.55; 95% confidence interval (CI), 0.31-0.93; p = 0.03). In contrast, there was no significant difference in the risk of major bleeding among the other DOACs. In the composite risk of ischemic stroke including TIA or systemic embolism, there was no significant difference among the four DOACs. This study suggested that in the current use of DOACs in Japanese patients with NVAF, dabigatran had a significantly lower risk of major bleeding than apixaban, but there was no significant difference in effectiveness among the four DOACs.
- Subjects :
- Male
medicine.medical_specialty
Pyridines
Pyridones
Administration, Oral
Pharmaceutical Science
Hemorrhage
Lower risk
Dabigatran
chemistry.chemical_compound
Japan
Rivaroxaban
Edoxaban
Internal medicine
Atrial Fibrillation
medicine
Humans
Aged
Ischemic Stroke
Retrospective Studies
Pharmacology
business.industry
Hazard ratio
Anticoagulants
Retrospective cohort study
Atrial fibrillation
General Medicine
Middle Aged
medicine.disease
Thiazoles
chemistry
Ischemic Attack, Transient
Pyrazoles
Female
Apixaban
business
Administrative Claims, Healthcare
medicine.drug
Subjects
Details
- ISSN :
- 13475215 and 09186158
- Volume :
- 44
- Database :
- OpenAIRE
- Journal :
- Biological and Pharmaceutical Bulletin
- Accession number :
- edsair.doi.dedup.....cee54465d2efa1c9de884aa1f1a9a48d