Dabigatran confers reduced bleeding risk in nonvalvular AF

Patients with nonvalvular atrial fibrillation who were treated with dabigatran had a decreased risk for major bleeding compared with those treated with rivaroxaban, according to an abstract presented at the International Stroke Conference.

There was no difference in bleeding risk in patients treated with dabigatran (Pradaxa, Boehringer Ingelheim) and apixaban (Eliquis, Bristol-Myers Squibb/Pfizer), and all three groups had similar risk for stroke.

“Analyses like this one are important because they continue to show how dabigatran is performing in the real world and impacting patients, which is an important outcome,” Todd C. Villines, MD, FSCCT, professor of medicine at the Uniformed Services University School of Medicine in Bethesda, Maryland, and director of cardiovascular research and cardiac CT and cardiology fellowship program director at the Walter Reed National Military Medical Center in Bethesda, told Cardiology Today. “However, this real-world comparison is not intended to suggest a clinical comparison between [non-vitamin K antagonist oral anticoagulants].”

Researchers reviewed data from two cohorts with patients with nonvalvular AF from the U.S. Department of Defense Military Health System.

In the first cohort, patients started treatment with 150 mg dabigatran or 20 mg rivaroxaban (Xarelto, Janssen) from July 2011 to June 2016. The second cohort included patients who initiated treatment with 150 mg dabigatran or 5 mg apixaban from 2013 to June 2016.

Propensity score matching was used in both cohorts, resulting in 12,763 patients for each agent in the first cohort (mean age, 71 years; 62% men) and 4,802 patients for each agent in the second cohort (mean age, 70 years; 63% men).

In the first cohort, 0.6% of patients in the dabigatran group had a stroke vs. 0.8% in the rivaroxaban group (HR = 0.77; 95% CI, 0.57-1.04). The incidence of stroke in the second cohort was 0.4% in both the dabigatran and apixaban groups (HR = 1.26; 95% CI, 0.66-2.39).

Patients assigned dabigatran in the first cohort were less likely to have major bleeding (2.1%) compared with those assigned rivaroxaban (2.5%; HR = 0.82; 95% CI, 0.7-0.97). Bleeding risk was similar in patients assigned dabigatran (1.6%) or apixaban (1.2%) in the second cohort (HR = 1.37; 95% CI, 0.97-1.94).

“While many studies have examined real-world outcomes with [non-vitamin K antagonist oral anticoagulants] relative to warfarin, there is limited data comparing [non-vitamin K antagonist oral anticoagulants] against each other in terms of risk of major bleeding and stroke,” Villines told Cardiology Today. “Continuing to assess [non-vitamin K antagonist oral anticoagulants] in the real-world setting is important for ensuring that physicians have the information they need to care for patients.” – by Darlene Dobkowski
Reference:

Villines TC, et al. Abstract 100. Presented at: International Stroke Conference; Jan. 23-26, 2018; Los Angeles.

Disclosures: Villines reports he is a member of the speakers bureau for Boehringer-Ingelheim. Please see the abstract for all other authors’ relevant financial disclosures.