Stroke, Bleeding, and Mortality Risks in Elderly Medicare Beneficiaries Treated With Dabigatran or Rivaroxaban for Nonvalvular Atrial Fibrillation.

@article{Graham2016StrokeBA,
  title={Stroke, Bleeding, and Mortality Risks in Elderly Medicare Beneficiaries Treated With Dabigatran or Rivaroxaban for Nonvalvular Atrial Fibrillation.},
  author={David J. Graham and Marsha E Reichman and Michael Wernecke and Ya-Hui Hsueh and Rima Izem and Mary Ross Southworth and Yuqin Wei and Jiemin Liao and Margie Rauch Goulding and Katrina Mott and Yoganand Chillarige and Thomas E MaCurdy and Christopher Worrall and Jeffrey Kelman},
  journal={JAMA internal medicine},
  year={2016},
  volume={176 11},
  pages={
          1662-1671
        },
  url={https://api.semanticscholar.org/CorpusID:20143121}
}
Treatment with rivaroxaban 20 mg once daily was associated with statistically significant increases in ICH and major extracranial bleeding, including major gastrointestinal bleeding, compared with dabigatran 150 mg twice daily, which indicated increased risk of stroke, bleeding, and mortality in patients with nonvalvular atrial fibrillation.
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286 Citations
Highly Influential Citations
6
Background Citations
43
Methods Citations
13
Results Citations
19

286 Citations

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Analysis of administrative claims data on new NVAF users of warfarin, dabigatran, apixaban, or rivaroxaban in routine clinical care from November 2010 to February 2015 added the perspective of a large real-world observational study that compared bleeding risks associated with NOACs during anticoagulation therapy.

Comparative effectiveness of rivaroxaban versus warfarin or dabigatran for the treatment of patients with non-valvular atrial fibrillation

In this large real-world sample of NVAF patients, effectiveness and risks of rivaroxaban versus warfarin differed by prior anticoagulant status, while effectiveness of r ivar oxaban versus dabigatran differed in GI bleeding risk.

Cost-effectiveness analysis of dabigatran versus rivaroxaban for stroke prevention in patients with non-valvular atrial fibrillation using real-world evidence in elderly US Medicare beneficiaries

Dabigatran was found to dominate rivaroxaban in this study using US Medicare real-world data, and results may not be generalizable to other patient populations.

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In older adults treated with direct-acting oral anticoagulants after ischemic stroke, outcome rates varied considerably by drug and dosage.

Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban.

In Medicare patients with atrial fibrillation receiving apixaban or rivaroxaban with atrial fibrillation treated with diltiazem or metoprolol, diltiazem was associated with greater risk of serious bleeding than metoprolol.

Risk for Bleeding-Related Hospitalizations During Use of Amiodarone With Apixaban or Rivaroxaban in Patients With Atrial Fibrillation

Patients aged 65 years or older with atrial fibrillation treated with amiodarone during apixaban or rivaroxaban use had greater risk for bleeding-related hospitalizations than those treated with flecainide or sotalol, antiarrhythmic drugs that do not inhibit these anticoagulants' elimination.

Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation.

Importance The comparative effectiveness of rivaroxaban and apixaban, the most frequently prescribed oral anticoagulants for ischemic stroke prevention in patients with atrial fibrillation, is…

Is There a Preferred Stroke Prevention Strategy for Diabetic Patients with Non-Valvular Atrial Fibrillation? Comparing Warfarin, Dabigatran and Rivaroxaban

In diabetic AF patients, dabigatran and rivaroxaban showed a superior or non-inferior effectiveness and safety profile compared with warfarin.

Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Previous Stroke or Transient Ischemic Attack

Results from the study of the 3 NOACs versus warfarin in nonvalvular atrial fibrillation patients with a previous history of stroke/ transient ischemic attack are relatively consistent with their respective phase III trials and previous stroke/transient isChemic attack subgroup analyses.

Direct comparisons of effectiveness and safety of treatment with Apixaban, Dabigatran and rivaroxaban in atrial fibrillation.

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43 References

Cardiovascular, Bleeding, and Mortality Risks in Elderly Medicare Patients Treated With Dabigatran or Warfarin for Nonvalvular Atrial Fibrillation

In general practice settings, dabigatran was associated with reduced risk of ischemic stroke, intracranial hemorrhage, and death and increased risk of major gastrointestinal hemorrhage compared with warfarin in elderly patients with nonvalvular atrial fibrillation.

Risk of bleeding with dabigatran in atrial fibrillation.

Dabigatran was associated with a higher incidence of major bleeding, a higher risk of gastrointestinal bleeding, but a lower risk of intracranial hemorrhage, and should be prescribed with caution, especially among high-risk patients.

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The risk of gastrointestinal bleeding related to novel oral anticoagulants was similar to that for warfarin, and caution should be used when prescribing novel oral anti-cancer drugs to older people, particularly those over 75 years of age.

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Although rates of gastrointestinal bleeding seem to be similar in this commercially insured sample of adults in the United States, this Retrospective cohort study cannot rule out as much as a 50% increase in the risk ofintestinal bleeding with dabigatran compared with warfarin or a more than twofold higher risk of bleeding with rivaroxaban compared withwarfarin.

Comparative Efficacy and Safety of New Oral Anticoagulants in Patients With Atrial Fibrillation

An indirect comparison of new anticoagulants based on existing trial data indicates that in patients with a CHADS2 score ≥3 dabigatran 150 mg, apixaban 5 mg, and rivaroxaban 20 mg resulted in statistically similar rates of stroke and systemic embolism, but apxaban had a lower risk of major hemorrhage compared with dabig atran and r ivaroxban.

Major Hemorrhage and Tolerability of Warfarin in the First Year of Therapy Among Elderly Patients With Atrial Fibrillation

Rates of hemorrhage derived from younger noninception cohorts underestimate the bleeding that occurs in practice, and this finding coupled with the short-term tolerability of warfarin likely contributes to its underutilization.

Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation

An updated meta-analysis of all currently available randomized trials that extends observations about the efficacy and safety of antithrombotic therapies for preventing stroke in patients who have atrial fibrillation is presented.

Rivaroxaban versus warfarin and dabigatran in atrial fibrillation: comparative effectiveness and safety in Danish routine care

To evaluate effectiveness and safety of rivaroxaban versus warfarin or dabigatran etexilate in a prospective cohort of routine care non‐valvular atrial fibrillation (AF) patients during February 2012…
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