DOACs show better safety, effectiveness than warfarin in patients with valvular afib
As a class, direct oral anticoagulants (DOACs) were associated with lower risk for ischemic stroke or systemic embolism and major bleeding events than warfarin, and results were consistent for apixaban and rivaroxaban.
Patients with valvular atrial fibrillation who were prescribed direct oral anticoagulants (DOACs) had lower risks for ischemic stroke or systemic embolism and major bleeding events compared with new users of warfarin, a study found.
Researchers used data from a practice-based commercial database to assess the safety and effectiveness of DOACs versus warfarin for adults with valvular atrial fibrillation who were newly prescribed either type of medication. The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism, and the primary safety outcome was a composite of intracranial or gastrointestinal bleeding. Results of the study were published March 30 by Annals of Internal Medicine.
The study included 56,336 propensity-score matched patients. DOACs were associated with lower risk for ischemic stroke or systemic embolism (hazard ratio [HR], 0.64 [95% CI, 0.59 to 0.70]) and major bleeding events (HR, 0.67 [95% CI, 0.63 to 0.72]). The results for the effectiveness and safety outcomes were consistent for apixaban (HRs, 0.54 [95% CI, 0.47 to 0.61] and 0.52 [95% CI, 0.47 to 0.57], respectively) and rivaroxaban (HRs, 0.74 [95% CI, 0.64 to 0.86] and 0.87 [95% CI, 0.79 to 0.96], respectively). Results for dabigatran were consistent for major bleeding (HR, 0.81 [95% CI, 0.68 to 0.97]) but not for effectiveness (HR, 1.03 [95% CI, 0.81 to 1.31]).
The authors noted that the study had a relatively short follow-up period and that they were unable to ascertain disease severity but said that the results could be used to guide treatment choice. “These findings have important clinical implications for patients with valvular [atrial fibrillation] who are at risk for poor outcomes; DOACs provide treatment options in patients who receive suboptimal benefits from warfarin therapy,” they wrote.