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Effectiveness and Safety of Direct Oral Anticoagulants Among Patients with Non-valvular Atrial Fibrillation and

Amol D Dhamane1, Mauricio Ferri1, Allison Keshishian2

  • 1Bristol Myers Squibb, Lawrenceville, NJ, USA.

Advances in Therapy
|December 17, 2022
PubMed

Insights

Direct oral anticoagulants (DOACs) show varied risks for stroke and bleeding in elderly non-valvular atrial fibrillation patients with multiple conditions. Apixaban demonstrated a favorable risk-benefit profile compared to dabigatran and rivaroxaban.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Rising incidence of atrial fibrillation in the aging US population.
  • Increased morbidity associated with aging and atrial fibrillation.
  • Need to evaluate direct oral anticoagulants (DOACs) in non-valvular atrial fibrillation (NVAF) patients with multimorbidity.

Purpose of the Study:

  • To assess the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) among elderly NVAF patients with multimorbidity on DOACs.
  • To compare the safety and efficacy of apixaban, dabigatran, and rivaroxaban in this patient population.
  • To analyze healthcare costs associated with different DOACs.

Main Methods:

  • Retrospective observational study using CMS Medicare database (2012-2017).
  • Inclusion of adult patients with NVAF and multimorbidity initiating apixaban, dabigatran, or rivaroxaban.
  • Propensity score matching (PSM) for 1:1 cohorts and Cox proportional hazard models to evaluate S/SE and MB risks.
  • Generalized linear models for all-cause healthcare cost estimation.

Main Results:

  • 36% of the study population had high multimorbidity (≥6 comorbidities).
  • Apixaban was associated with lower S/SE and MB risks compared to dabigatran and rivaroxaban.
  • Dabigatran showed lower S/SE risk and similar MB risk versus rivaroxaban.
  • Apixaban use was linked to lower healthcare costs compared to rivaroxaban.

Conclusions:

  • Significant differences in stroke/SE and MB risks exist among DOACs in NVAF patients with high multimorbidity.
  • DOAC selection impacts healthcare expenses in this population.
  • Findings aid in evaluating the risk-benefit ratio of DOACs for NVAF patients with comorbid conditions.
Abstract

Keywords:
Atrial fibrillationBleedingMultimorbidityOral anticoagulantStrokeSystemic embolism

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