Stroke, Major Bleed Risk Compared Among Novel Oral Anticoagulants

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The study analyzed data from NVAF patients newly initiating treatment with dabigatran, rivaroxaban or apixaban.

Results from a retrospective, observational real-world study examining major bleed and stroke rates in non-valvular atrial fibrillation (NVAF) patients taking novel oral anticoagulants (NOACs) were presented at the International Stroke Conference 2018.

The study involved NVAF patients from the U.S. Department of Defense Military Health System who initiated treatment with dabigatran etexilate mesylate, rivaroxaban or apixaban. The analysis contained 2 matched cohorts; 12,763 dabigatran (150mg twice daily) and rivaroxaban (20mg daily) patients, and 4,802 dabigatran (150mg twice daily) and apixaban (5mg daily) patients.

Compared to the rivaroxaban group, dabigatran-treated patients had lower rates of major bleeding  (2.53% vs. 2.08%, respectively; HR 0.82; 95% CI 0.70-0.97; P=0.0182). There were similar rates of stroke between dabigatran and rivaroxaban patients (0.60% vs 0.78%, respectively; HR 0.77, CI 0.57-1.04; P=0.0844). 

In the second cohort, dabigatran- and apixaban-treated patients experienced similar rates of major bleeding (1.60% vs. 1.21%, respectively; HR 1.37, CI 0.97-1.94; P=0.0702]  and stroke (0.44% vs. 0.35%, respectively; HR 1.26, CI 0.66-2.39; P=0.4892).

“With an increasing number of the 2.7 million Americans living with atrial fibrillation being treated with NOACs, real-world analyses like this that compare their effectiveness and safety are important,” said Todd C. Villines, M.D., Assistant Professor of Medicine at Georgetown School of Medicine, and lead investigator of the study. 

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