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Abstract Details

Comparative Effectiveness and Safety of Non-vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Non-valvular Atrial Fibrillation Patients: The Dose Subgroup Analysis of the ARISTOPHANES Study
Cerebrovascular Disease and Interventional Neurology
S35 - Stroke Prevention Strategies (1:33 PM-1:44 PM)
004

Limited real-world evidence exists on comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin by NOAC dosage.

This subgroup analysis of the ARISTOPHANES (Anticoagulants for Reduction In STroke: Observational Pooled analysis on Health outcomes ANd Experience of patientS) study aimed to compare stroke/systemic embolism (S/SE), major bleeding (MB), and their respective components among non-valvular atrial fibrillation (NVAF) patients prescribed NOACs or warfarin, stratified by index NOAC dosage.

A retrospective observational study of NVAF patients initiating apixaban, dabigatran, rivaroxaban, or warfarin from 01JAN2013-30SEP2015 was conducted using CMS Medicare data and four US commercial claims databases, covering >180 million beneficiaries annually. Patient records were pooled after propensity score matching in each database between standard NOAC doses and warfarin (5mg BID apixaban-warfarin, 150mg BID dabigatran-warfarin, and 20mg QD rivaroxaban-warfarin), as well as lower NOAC doses and warfarin (2.5mg BID apixaban-warfarin, 75mg BID dabigatran-warfarin, and 10 or 15mg QD rivaroxaban-warfarin). Cox models were used to estimate S/SE and MB hazard ratios. 

Standard- and lower-dose apixaban patients were each associated with lower rates of S/SE and MB versus warfarin. Standard- and lower-dose dabigatran patients each had similar rates of S/SE compared to warfarin. Standard-dose dabigatran patients had a lower rate of MB and lower-dose dabigatran patients had a similar rate of MB versus warfarin. Standard-dose rivaroxaban patients were associated with a lower S/SE rate, and lower-dose rivaroxaban patients had a similar rate of S/SE compared to warfarin. Standard- and lower-dose rivaroxaban patients were each associated with higher MB rates compared to warfarin. All doses of NOACs were associated with lower rates of ICH compared to warfarin. 

In this study, only apixaban was associated with lower rates of S/SE and MB for both doses compared to warfarin. Future studies of patients who were appropriately dosed are warranted.

Authors/Disclosures

PRESENTER
No disclosure on file
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Xiaoyan Li, MD (Duke University) Dr. Li has nothing to disclose.
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