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Comparative Effectiveness and Safety of Standard or Reduced Dose Dabigatran vs. Rivaroxaban in Nonvalvular Atrial Fibrillation
Author(s) -
Blin Patrick,
DureauPournin Caroline,
Cottin Yves,
Bénichou Jacques,
Mismetti Patrick,
Abouelfath Abdelilah,
Lassalle Regis,
Droz Cécile,
Moore Nicholas
Publication year - 2019
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.1318
Subject(s) - rivaroxaban , dabigatran , medicine , atrial fibrillation , hazard ratio , warfarin , stroke (engine) , confidence interval , anesthesia , cardiology , mechanical engineering , engineering
Dabigatran and rivaroxaban at standard or reduced doses have been compared to warfarin in nonvalvular atrial fibrillation ( NVAF ), but not to each other. This was a new user study of standard dose and reduced dose dabigatran or rivaroxaban for NVAF in the French healthcare database, matched on gender, age, date of first dispensing, and high‐dimensional propensity score, followed 2 years. Hazard ratios (HRs; 95% confidence intervals (CI)) of stroke or systemic embolism ( SSE ), major bleeding ( MB ), or death were computed. In matched standard‐dose patients (8,290 per arm), mean age 67 years, HR s for dabigatran vs. rivaroxaban were SSE 0.92 (95% CI = 0.67–1.26), MB 0.59 (95% CI = 0.39–0.90), and death 0.84 (95% CI = 0.65–1.11). In reduced‐dose patients (7,639 per arm), mean age 80 years, HR s for dabigatran vs. rivaroxaban were SSE 0.73 (95% CI = 0.59–0.94), MB 0.74 (95% CI = 0.57–0.96), and death 0.95 (95% CI = 0.83–1.09). In conclusion, at either dose, dabigatran had similar or better effectiveness than rivaroxaban but lower bleeding risk. Death rates were not different.