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Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared With Warfarin Among Long-term Anticoagulated Patients for Atrial Fibrillation.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2016 Jul 15; Vol. 118 (2), pp. 210-4. Date of Electronic Publication: 2016 May 05. - Publication Year :
- 2016
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Abstract
- Direct oral anticoagulants (DOACs) have been used in clinical practice in the United States for the last 4 to 6 years. Although DOACs may be an attractive alternative to warfarin in many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/transient ischemic attack (TIA), bleeding, major bleeding, and dementia in patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation from June 2010 to December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score. Multivariable Cox hazard regression was performed to determine the risk of death, stroke/TIA, major bleed, and dementia by the anticoagulant therapy received. A total of 5,254 patients were studied (2,627 per group). Average age was 72.4 ± 10.9 years, and 59.0% were men. Most patients were receiving long-term anticoagulation for AF management (warfarin: 96.5% vs DOAC: 92.7%, p <0.0001). Rivaroxaban (55.3%) was the most commonly used DOAC, followed by apixaban (22.5%) and dabigatran (22.2%). The use of DOACs compared with warfarin was associated with a reduced risk of long-term adverse outcomes: death (p = 0.09), stroke/TIA (p <0.0001), major bleed (p <0.0001), and bleed (p = 0.14). No significant outcome variance was noted in DOAC-type comparison. In the AF multivariable model patients taking DOAC were 43% less likely to develop stroke/TIA/dementia (hazard ratio 0.57 [CI 0.17, 1.97], p = 0.38) than those taking warfarin. Our community-based results suggest better long-term efficacy and safety of DOACs compared with warfarin. DOAC use was associated with a lower risk of cerebral ischemic events and new-onset dementia.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Antithrombins therapeutic use
Atrial Fibrillation complications
Dabigatran therapeutic use
Dementia epidemiology
Factor Xa Inhibitors therapeutic use
Female
Hemorrhage epidemiology
Humans
Ischemic Attack, Transient epidemiology
Ischemic Attack, Transient etiology
Male
Middle Aged
Mortality
Multivariate Analysis
Propensity Score
Proportional Hazards Models
Pyrazoles therapeutic use
Pyridones therapeutic use
Rivaroxaban therapeutic use
Stroke epidemiology
Stroke etiology
Warfarin therapeutic use
Anticoagulants therapeutic use
Atrial Fibrillation drug therapy
Ischemic Attack, Transient prevention & control
Stroke prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 118
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 27236255
- Full Text :
- https://doi.org/10.1016/j.amjcard.2016.04.039