Ujeyl, Mariam, Koester, Ingrid, Wille, Hans, Stammschulte, Thomas, Hein, Rebecca, Harder, Sebastian, Gundert-Remy, Ursula, Bleek, Julian, Ihle, Peter, Schroeder, Helmut, Schillinger, Gerhard, Zawinell, Anette and Schubert, Ingrid (2018). Comparative risks of bleeding, ischemic stroke and mortality with direct oral anticoagulants versus phenprocoumon in patients with atrial fibrillation. Eur. J. Clin. Pharmacol., 74 (10). S. 1317 - 1326. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1432-1041

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Abstract

PurposeThe pivotal trials for stroke prevention in non-valvular atrial fibrillation (NVAF) compared rivaroxaban, dabigatran, and apixaban with warfarin, as did most claims-based studies. Comparisons with phenprocoumon, the most frequently used vitamin K antagonist (VKA) in Germany, are scarce.MethodsRisk of bleeding, ischemic stroke, and all-cause mortality in patients with NVAF were analyzed using data for 2010 to 2014 from a large German claims database. New users of oral anticoagulants from January 2012 to December 2013 were included and observed over 1year. Baseline characteristics were adjusted using propensity score matching and logistic regression. Several sensitivity analyses were carried out.ResultsFifty-nine thousand four hundred forty-nine rivaroxaban, 23,654 dabigatran, 4894 apixaban, and 87,997 matched phenprocoumon users were included. Adjusted hazard ratios (95% confidence intervals) compared with phenprocoumon were as follows: hospitalized bleedings: rivaroxaban 1.04 (0.97; 1.11), dabigatran 0.87 (0.77; 0.98), and apixaban 0.65 (0.50; 0.86); ischemic stroke: rivaroxaban 1.05 (0.94; 1.17), dabigatran 1.14 (0.96; 1.35), and apixaban 1.84 (1.20; 2.84); all-cause mortality: rivaroxaban 1.17 (1.11; 1.22), dabigatran 1.04 (0.95; 1.13), and apixaban 1.14 (0.97; 1.34).ConclusionsWith rivaroxaban, no significant differences were observed compared to phenprocoumon with regard to hospitalized bleedings or ischemic strokes. Dabigatran was associated with fewer bleedings and a similar risk of ischemic strokes compared to phenprocoumon. Apixaban was also associated with fewer bleedings but was unexpectedly associated with more ischemic strokes, possibly reflecting selective prescribing. The association of rivaroxaban with higher all-cause mortality unrelated to bleedings or strokes has been described previously but remains to be explained.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Ujeyl, MariamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koester, IngridUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wille, HansUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stammschulte, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hein, RebeccaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Harder, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gundert-Remy, UrsulaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bleek, JulianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ihle, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schroeder, HelmutUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schillinger, GerhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zawinell, AnetteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schubert, IngridUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-172151
DOI: 10.1007/s00228-018-2504-7
Journal or Publication Title: Eur. J. Clin. Pharmacol.
Volume: 74
Number: 10
Page Range: S. 1317 - 1326
Date: 2018
Publisher: SPRINGER HEIDELBERG
Place of Publication: HEIDELBERG
ISSN: 1432-1041
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
WORLD CLINICAL-PRACTICE; REAL-WORLD; WARFARIN; DABIGATRAN; PREVENTION; SAFETY; METAANALYSIS; RIVAROXABAN; APIXABAN; EFFICACYMultiple languages
Pharmacology & PharmacyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/17215

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