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E-pub ahead of print

Effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in atrial fibrillation: a scandinavian population-based cohort study

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

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  • Sigrun Halvorsen
  • Søren P Johnsen
  • Morten Madsen
  • Marie Linder
  • Gerhard Sulo
  • Waleed Ghanima
  • Gunnar Gislason
  • Stefan H Hohnloser
  • Aaron Jenkins
  • Faris Al-Khalili
  • Grethe S Tell
  • Vera Ehrenstein
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AIMS: Using Scandinavian population-based registries, we assessed risk of stroke/systemic embolism (SE) and bleeding with non-vitamin K antagonist oral anticoagulants compared with warfarin in oral anticoagulation-naïve patients with atrial fibrillation (AF).

METHODS AND RESULTS: This historical cohort study included 219,545 AF patients (median age, 74 years; 43% women; mean CHA2DS2-VASc score 3.3) initiating apixaban, dabigatran, rivaroxaban, or warfarin in Denmark, Norway, and Sweden 01JAN2013-31DEC2016. The primary endpoints were stroke/SE and major bleeding. The median follow-up times were 9.7 (3.9-21.5) months for stroke/SE and 9.6 (3.8-21.3) months for bleeding. Apixaban and warfarin initiators were older and had higher CHA2DS2-VASc scores compared with dabigatran and rivaroxaban initiators. After 1:1 propensity score matching, three cohorts were created: apixaban-warfarin (n = 111,162), dabigatran-warfarin (n = 56,856), and rivaroxaban-warfarin (n = 61,198). Adjusted hazard ratios (HRs) were estimated using a Cox regression. For stroke/SE, adjusted HRs against warfarin were 0.96 (95% confidence interval [CI], 0.87-1.06) for apixaban; 0.89 (95% CI, 0.80-1.00) for dabigatran; and 1.03 (95% CI, 0.92-1.14) for rivaroxaban. For major bleeding, the HRs against warfarin were 0.73 (95% CI, 0.67-0.78) for apixaban; 0.89 (95% CI, 0.82-0.97) for dabigatran; and 1.15 (95% CI, 1.07-1.25) for rivaroxaban. The results in the dabigatran cohort did not hold in all dosedefined subgroups.

CONCLUSIONS: In this large Scandinavian study among AF patients initiating oral anticoagulation, those initiating dabigatran, apixaban, and rivaroxaban had similar rates of stroke/SE as patients initiating warfarin. Rates of major bleeding were lower with apixaban and dabigatran and higher with rivaroxaban, each compared with warfarin.

OriginalsprogEngelsk
TidsskriftEuropean heart journal. Quality of care & clinical outcomes
ISSN2058-5225
DOI
StatusE-pub ahead of print - 9 jul. 2021

Bibliografisk note

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

ID: 70545405