Journal article
Sex-Specific Comparative Effectiveness of Oral Anticoagulants in Elderly Patients With Newly Diagnosed Atrial Fibrillation
Circulation Cardiovascular quality and outcomes, Vol.10(4), e003418
04/2017
DOI: 10.1161/CIRCOUTCOMES.116.003418
PMCID: PMC5412710
PMID: 28408716
Abstract
Sex-specific comparative effectiveness of direct oral anticoagulants among patients with nonvalvular atrial fibrillation is not known. Via this retrospective cohort study, we assessed the sex-specific, comparative effectiveness of direct oral anticoagulants (rivaroxaban and dabigatran), compared to each other and to warfarin among patients with atrial fibrillation.
Elderly (aged ≥66 years) Medicare beneficiaries enrolled in Medicare Part D benefit plan from November 2011 to October 2013 with newly diagnosed atrial fibrillation formed the study cohort (65 734 [44.8%] men and 81 137 [55.2%] women). Primary outcomes of inpatient admissions for ischemic strokes and major bleeding were compared across the 3 drugs (rivaroxaban: 20 mg QD, dabigatran: 150 mg BID, or warfarin) using 3-way propensity-matched samples. In men, rivaroxaban use decreased stroke risk when compared with warfarin use (hazard ratio, 0.69; 95% confidence interval, 0.48-0.99;
=0.048) and dabigatran use (hazard ratio, 0.66; 95% confidence interval, 0.45-0.96;
=0.029) and was associated with a similar risk of any major bleeding when compared with warfarin and dabigatran. In women, although ischemic stroke risk was similar in the 3 anticoagulant groups, rivaroxaban use significantly increased the risk for any major bleeding when compared with warfarin (hazard ratio, 1.20; 95% confidence interval, 1.03-1.42;
=0.021) and dabigatran (hazard ratio, 1.27; 95% confidence interval, 1.09-1.48;
=0.011).
The reduced risk of ischemic stroke in patients taking rivaroxaban, compared with dabigatran and warfarin, seems to be limited to men, whereas the higher risk of bleeding seems to be limited to women.
Details
- Title: Subtitle
- Sex-Specific Comparative Effectiveness of Oral Anticoagulants in Elderly Patients With Newly Diagnosed Atrial Fibrillation
- Creators
- Ghanshyam Palamaner Subash Shantha - From the Department of Cardiovascular Medicine (G.P.S.S., P.D.B., S.G., D.H.-Z., A.M., M.G.) and Department of Internal Medicine (M.S.V.S.), Roy and Lucille J. Carver College of Medicine and Department of Epidemiology, College of Public Health (E.C.), University of Iowa, Iowa City; and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, IA (M.S.V.S.)Prashant D Bhave - From the Department of Cardiovascular Medicine (G.P.S.S., P.D.B., S.G., D.H.-Z., A.M., M.G.) and Department of Internal Medicine (M.S.V.S.), Roy and Lucille J. Carver College of Medicine and Department of Epidemiology, College of Public Health (E.C.), University of Iowa, Iowa City; and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, IA (M.S.V.S.)Saket Girotra - From the Department of Cardiovascular Medicine (G.P.S.S., P.D.B., S.G., D.H.-Z., A.M., M.G.) and Department of Internal Medicine (M.S.V.S.), Roy and Lucille J. Carver College of Medicine and Department of Epidemiology, College of Public Health (E.C.), University of Iowa, Iowa City; and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, IA (M.S.V.S.)Denice Hodgson-Zingman - From the Department of Cardiovascular Medicine (G.P.S.S., P.D.B., S.G., D.H.-Z., A.M., M.G.) and Department of Internal Medicine (M.S.V.S.), Roy and Lucille J. Carver College of Medicine and Department of Epidemiology, College of Public Health (E.C.), University of Iowa, Iowa City; and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, IA (M.S.V.S.)Alexander Mazur - From the Department of Cardiovascular Medicine (G.P.S.S., P.D.B., S.G., D.H.-Z., A.M., M.G.) and Department of Internal Medicine (M.S.V.S.), Roy and Lucille J. Carver College of Medicine and Department of Epidemiology, College of Public Health (E.C.), University of Iowa, Iowa City; and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, IA (M.S.V.S.)Michael Giudici - From the Department of Cardiovascular Medicine (G.P.S.S., P.D.B., S.G., D.H.-Z., A.M., M.G.) and Department of Internal Medicine (M.S.V.S.), Roy and Lucille J. Carver College of Medicine and Department of Epidemiology, College of Public Health (E.C.), University of Iowa, Iowa City; and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, IA (M.S.V.S.)Elizabeth Chrischilles - From the Department of Cardiovascular Medicine (G.P.S.S., P.D.B., S.G., D.H.-Z., A.M., M.G.) and Department of Internal Medicine (M.S.V.S.), Roy and Lucille J. Carver College of Medicine and Department of Epidemiology, College of Public Health (E.C.), University of Iowa, Iowa City; and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, IA (M.S.V.S.)Mary S Vaughan Sarrazin - From the Department of Cardiovascular Medicine (G.P.S.S., P.D.B., S.G., D.H.-Z., A.M., M.G.) and Department of Internal Medicine (M.S.V.S.), Roy and Lucille J. Carver College of Medicine and Department of Epidemiology, College of Public Health (E.C.), University of Iowa, Iowa City; and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, IA (M.S.V.S.). mary-vaughan-sarrazin@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- Circulation Cardiovascular quality and outcomes, Vol.10(4), e003418
- Publisher
- United States
- DOI
- 10.1161/CIRCOUTCOMES.116.003418
- PMID
- 28408716
- PMCID
- PMC5412710
- ISSN
- 1941-7705
- eISSN
- 1941-7705
- Grant note
- R01 HS023104 / AHRQ HHS K08 HL122527 / NHLBI NIH HHS
- Language
- English
- Date published
- 04/2017
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Pharmacy; Health Management and Policy; Epidemiology; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9983996190302771
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