Delaying clinical events among patients with non-valvular atrial fibrillation treated with oral anticoagulants: Insights from the ARISTOPHANES study

Deitelzweig, Steven, Keshishian, Allison, Kang, Amiee, Jenkins, Aaron, Atreja, Nipun, Schuler, Patricia, Jiang, Jenny, Yuce, Huseyin, Sun, Xiaoxi and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2023) Delaying clinical events among patients with non-valvular atrial fibrillation treated with oral anticoagulants: Insights from the ARISTOPHANES study. EUROPEAN JOURNAL OF INTERNAL MEDICINE, 108. pp. 37-42.

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Official URL: http://dx.doi.org/10.1016/j.ejim.2022.10.021

Abstract

<h4>Background</h4>Oral anticoagulants (OACs) mitigate stroke and systemic embolism (SE) risk in non-valvular atrial fibrillation (AF) patients but can increase the risk of major bleeding (MB). This study analyzed the gains in event-free time for these outcomes among OAC treatment options represented in the ARISTOPHANES study.<h4>Methods</h4>This sub-analysis consisted of NVAF patients who initiated warfarin, apixaban, dabigatran, or rivaroxaban from 01JAN2013-30SEP2015, with data pooled from Medicare and 4 US commercial claims databases. Propensity score matching was conducted between non-vitamin K antagonist OAC (NOAC) and warfarin cohorts in each database and results were pooled. Laplace regression was used to evaluate the delay in time to stroke/SE and MB events between NOACs and warfarin and between NOACs after the first 12-months of follow-up.<h4>Results</h4>The population included 466,991 patients (167,413 warfarin; 108,852 apixaban; 37,724 dabigatran; and 153,002 rivaroxaban). Event-free time gain (95% confidence interval) for apixaban versus warfarin was 101 days (78- 124) for stroke/SE and 116 (103- 130) days for MB. The gain in event-free time for dabigatran versus warfarin was 45 days (3- 87) for stroke/SE and 92 (68- 116) days for MB. The gain in event-free time for rivaroxaban versus warfarin was 63 days (42- 84) for stroke/SE but event-free time decreased by 18 (-31-6) days for MB.<h4>Conclusions</h4>Over 12 months after initiation, apixaban and dabigatran conferred progressive increases in event free time for stroke/SE and MB vs warfarin, whereas rivaroxaban conferred an increase in stroke/SE-free time but a loss in MB-free time vs warfarin.

Item Type:	Article
Uncontrolled Keywords:	Oral anticoagulant therapy, Atrial fibrillation, Non-vitamin K antagonist oral anticoagulant, Direct oral anticoagulant, Non-valvular atrial fibrillation, NVAF
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	29 Sep 2023 10:36
Last Modified:	29 Sep 2023 10:36
DOI:	10.1016/j.ejim.2022.10.021
Open Access URL:	https://doi.org/10.1016/j.ejim.2022.10.021
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3173215