Risk of Stroke and Death in Atrial Fibrillation by Type of Anticoagulation: A Propensity-Matched Analysis

Leef, George; Qin, Dingxin; Althouse, Andrew D.; Alam, Mian Bilal; Rattan, Rishi; Munir, Muhammad Bilal; Patel, Divyang; Khattak, Furqan; Vaghasia, Nishit; Adelstein, Evan; Jain, Sandeep; Saba, Samir

doi:10.1111/pace.12695

Cited by 6 publications

(12 citation statements)

References 24 publications

(55 reference statements)

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“…All studies were conducted in USA, except one study from Denmark [47] and one from Canada [53]. Two studies reported data on both dabigatran and rivaroxaban [44,51], six studies investigated dabigatran only [45, 47-49, 52, 53], one study provided information only on rivaroxaban [46], and one study did not specify the type of NOACs [50] (Table 1). No data on treatment discontinuation or compliance were reported in the included PS studies.…”

Section: Ps Studiesmentioning

confidence: 99%

“…All included studies were retrospective cohort designs, using the administrative databases and focusing on new users of anticoagulants. The mean age of participants varied from 64 years [50] to 75 years [45] old. All studies were conducted in USA, except one study from Denmark [47] and one from Canada [53].…”

Section: Ps Studiesmentioning

confidence: 99%

“…Most PS studies (60 %) used the method of matching for analyses [44,46,47,49,50,52], while two studies used the inverse probability of treatment weighting method [45,48], and two used the covariate adjustment approach [51,53] ( Table 1). Details on PS calculation were provided for seven studies [44][45][46][47][48][49]52], and eight studies examined the balance between NOACs and warfarin groups before and after using the PS method [44][45][46][47][48][49][50]52].…”

Section: Ps Studiesmentioning

confidence: 99%

“…Among the 10 PS studies [44][45][46][47][48][49][50][51][52][53] (Table 1), there were 494,964 patients in total included for PS analyses. Except for the two abstracts with unknown sex composition [51,53], the proportion of female sex was 46 % (n = 139,973) in the remaining eight studies.…”

Section: Ps Studiesmentioning

confidence: 99%

“…We screened full-length texts for 83 potentially included studies, with a Kappa statistic of 0.82 (95 % CI 0.68-0.96) between the reviewers. Fifteen studies (five RCTs [39][40][41][42][43], ten PS studies including seven full-length texts [44][45][46][47][48][49][50] and three abstracts [51][52][53]) met the inclusion criteria and were included in the final meta-analyses. The study selection process for this systematic review is shown in Fig.…”

Section: Study Identificationmentioning

confidence: 99%

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Comparison of treatment effect estimates of non-vitamin K antagonist oral anticoagulants versus warfarin between observational studies using propensity score methods and randomized controlled trials

Holbrook

Jin

et al. 2016

Eur J Epidemiol

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Emerging observational studies using propensity score (PS) methods assessed real-world comparative effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients with non-valvular atrial fibrillation (AF). We aimed to compare treatment effect estimates of NOACs between PS studies and randomized controlled trials (RCTs). Electronic databases and conference proceedings were searched systematically. Primary outcomes included stroke or systemic embolism (SE) and major bleeding. A random-effects meta-analysis was performed to synthesize the data by pooling the PS- and RCT-derived hazard ratios (HRs) separately. The ratio of HRs (RHR) from the ratio of PS-derived HRs relative to RCT-derived HRs was used to determine whether there was a difference between estimates from PS studies and RCTs. There were 10 PS studies and 5 RCTs included for analysis. No significant difference of treatment effect estimates between the PS studies and RCTs was observed: RHR 1.11, 95 % CI 0.98-1.23 for stroke or SE; RHR 1.07, 95 % CI 0.87-1.34 for major bleeding. A significant association between NOACs and risk of stroke or SE was observed: HR 0.88, 95 % CI 0.83-0.94 for the PS studies; HR 0.79, 95 % CI 0.72-0.87 for the RCTs. However, no relationship between NOACs and risk of major bleeding was found: HR 0.91, 95 % CI 0.79-1.05 for the PS studies; HR 0.85, 95 % CI 0.73-1.00 for the RCTs. In this study, treatment effect estimates of NOACs versus warfarin in patients with non-valvular AF from PS studies are found to be in agreement with those from RCTs.

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Section: Ps Studiesmentioning

confidence: 99%

Section: Ps Studiesmentioning

confidence: 99%

Section: Ps Studiesmentioning

confidence: 99%

Section: Ps Studiesmentioning

confidence: 99%

Section: Study Identificationmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of treatment effect estimates of non-vitamin K antagonist oral anticoagulants versus warfarin between observational studies using propensity score methods and randomized controlled trials

Holbrook

Jin

et al. 2016

Eur J Epidemiol

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Mortality risk in atrial fibrillation: the role of aspirin, vitamin K and non-vitamin K antagonists

et al. 2019

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Background As an alternative to vitamin K antagonist and low-dose aspirin (< 325 mg), non-vitamin K oral anticoagulants are available for the prevention of stroke in patients with atrial fibrillation. However, the mortality risk associated with these drugs in daily practice remains unclear. Objective To evaluate the risk of all-cause mortality associated with non-Vitamin K antagonist oral anticoagulants, vitamin K antagonists or aspirin in patients with atrial fibrillation. Setting A cohort study conducted among atrial fibrillation patients using the UK Clinical Practice Research Datalink (March 2008-October 2014). Method New users of vitamin K antagonists, non vitamin K oral anticoagulants, low-dose aspirin, or combination therapy were followed from the date of first prescription to the date of death, as recorded in the UK datalink. Cox proportional hazard models estimated the hazard ratio (HR) of all-cause mortality for users of NOACs, aspirin, or combination use, as compared to vitamin K antagonist. Analyses were adjusted for confounders. Main outcome measure All-cause mortality. Results We identified 31,497 patients. Non vitamin K antocoagulant use (adjusted HR [aHR] = 1.42; 95% Confidence Interval [CI] 1.18-1.71) and aspirin use (aHR = 1.64; 95% CI 1.57-1.77) were both significantly associated with a higher mortality risk than use of vitamin K antagonists. The higher mortality risk for the non vitamin K anticoagulant use was observed in men (aHR = 1.72; 95% CI 1.25-2.36), but not in women (aHR = 1.28; 95% CI 0.92-1.79. Compared to vitamin K antagonists, mortality risk associated with the non vitamin K anticoagulants and aspirin use was significantly increased in patients with higher stroke risk (CHA 2 DS 2-VASc > 2). Conclusion Non vitamin K oral anticoagulants are associated with a higher risk on all-cause mortality, particularly in men and in patients with higher stroke risk.

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Effectiveness and safety of oral anticoagulation with non-vitamin K antagonists compared to well-managed vitamin K antagonists in naïve patients with non-valvular atrial fibrillation: Propensity score matched cohort study

Denas

Gennaro

Ferroni

et al. 2017

International Journal of Cardiology

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Risk of Stroke and Death in Atrial Fibrillation by Type of Anticoagulation: A Propensity-Matched Analysis

Abstract: Compared to warfarin, NOAC use is associated with decreased all-cause mortality but not stroke risk. These data from real-life clinical practice add to existing evidence for decreased mortality among patients prescribed NOACs compared to warfarin.

Cited by 6 publications

References 24 publications

Comparison of treatment effect estimates of non-vitamin K antagonist oral anticoagulants versus warfarin between observational studies using propensity score methods and randomized controlled trials

Comparison of treatment effect estimates of non-vitamin K antagonist oral anticoagulants versus warfarin between observational studies using propensity score methods and randomized controlled trials

Mortality risk in atrial fibrillation: the role of aspirin, vitamin K and non-vitamin K antagonists

Effectiveness and safety of oral anticoagulation with non-vitamin K antagonists compared to well-managed vitamin K antagonists in naïve patients with non-valvular atrial fibrillation: Propensity score matched cohort study

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