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Comparative Effectiveness of Dabigatran, Rivaroxaban, Apixaban, and Warfarin in the Management of Patients With Nonvalvular Atrial Fibrillation
Author(s) -
Pink J,
Pirmohamed M,
Hughes D A
Publication year - 2013
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 - 10.1038/clpt.2013.83
Subject(s) - apixaban , dabigatran , rivaroxaban , warfarin , medicine , atrial fibrillation , stroke (engine) , anticoagulant , cardiology , anesthesia , intensive care medicine , mechanical engineering , engineering
Alternative anticoagulants to warfarin (dabigatran, rivaroxaban, and apixaban) are becoming available for the prevention of thromboembolic stroke in atrial fibrillation (AF), but there is a lack of information on their comparative effectiveness. Using a discrete event simulation method adopting a lifetime horizon of analysis, we made an indirect comparison of the RE‐LY, ROCKET‐AF, and ARISTOTLE trial results for AF patients in the US population. Over a lifetime, apixaban, dabigatran, and rivaroxaban accrued 0.130 (95% central range (CR) −0.030 to 0.264), 0.106 (95% CR −0.048 to 0.248), and 0.095 (95% CR −0.052 to 0.242) more quality‐adjusted life‐years (QALYs), respectively, than warfarin, with apixaban having a 55% probability of accruing the highest total QALYs. In the absence of a definitive trial, and acknowledging the limitations of an indirect comparison, the available evidence suggests apixaban to be the most effective anticoagulant. Clinical Pharmacology & Therapeutics (2013); 94 2, 269–276. doi: 10.1038/clpt.2013.83