Hohnloser, Stefan H., Basic, Edin, Hohmann, Christopher and Nabauer, Michael (2018). Effectiveness and Safety of Non-Vitamin K Oral Anticoagulants in Comparison to Phenprocoumon: Data from 61,000 Patients with Atrial Fibrillation. Thromb. Haemost., 118 (3). S. 526 - 539. STUTTGART: GEORG THIEME VERLAG KG. ISSN 2567-689X

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Abstract

All pivotal trials have evaluated non-vitamin K oral antagonists (NOACs) against warfarin. However, in some regions of the world, phenprocoumon is the most widely used vitamin K antagonist (VKA). There is little evidence documenting effectiveness and safety of NOACs compared with phenprocoumon in atrial fibrillation (AF). Aretrospective cohort study using a German claims database was conducted to assess effectiveness (stroke, systemic embolism [SE]) and safety (bleeding leading to hospitalization) during therapy with NOACs and phenprocoumon in 61,205 AF patients. Hazard ratios (HRs) for effectiveness and safety outcomes were derived from Cox proportional hazard models, adjusting for baseline characteristics. Propensity score matching was performed as a sensitivity analysis. As a prespecified subgroup analysis, the effects of reduced NOAC dosing were compared with phenprocoumon. A total of 61,205 patients were identified in whom phenprocoumon (n = 23,823, 38.9%), apixaban (n = 10,117, 16.5%), dabigatran (n = 5,122, 8.4%), or rivaroxaban (n = 22,143, 36.2%) was initiated. After adjusting for baseline confounders, all three NOACs tested had significantly lower risks of stroke/SE compared with phenprocoumon (apixaban-HR: 0.77, 95% CI: 0.66-0.90; dabigatran-HR: 0.74, 95% CI: 0.60-0.91; rivaroxaban-HR: 0.86, 95% CI: 0.76-0.97). Apixaban (HR: 0.58, 95% CI: 0.49-0.69) and dabigatran (HR: 0.64, 95% CI: 0.50-0.80) were associated with lower bleeding risks than phenprocoumon, whereas the risk was similar for rivaroxaban and phenprocoumon. All threeNOACs showed reduced riskof intracranial bleeding compared with phenprocoumon. Reduced doses of NOACs were predominantly used in patients with advanced age and comorbidities with generally similar effectiveness and safety benefits compared with phenprocumon as standard-dose NOACs.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Hohnloser, Stefan H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Basic, EdinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hohmann, ChristopherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nabauer, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-193647
DOI: 10.1160/TH17-10-0733
Journal or Publication Title: Thromb. Haemost.
Volume: 118
Number: 3
Page Range: S. 526 - 539
Date: 2018
Publisher: GEORG THIEME VERLAG KG
Place of Publication: STUTTGART
ISSN: 2567-689X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
DAILY-CARE PATIENTS; PROPENSITY SCORE; WARFARIN; DABIGATRAN; APIXABAN; THERAPY; RIVAROXABAN; RISK; ADHERENCE; QUALITYMultiple languages
Hematology; Peripheral Vascular DiseaseMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/19364

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