Affordable Access

deepdyve-link
Publisher Website

Dabigatran versus vitamin K antagonists for atrial fibrillation in clinical practice: final outcomes from Phase III of the GLORIA-AF registry

Authors
  • Huisman, Menno V.
  • Teutsch, Christine
  • Lu, Shihai
  • Diener, Hans-Christoph
  • Dubner, Sergio J.
  • Halperin, Jonathan L.
  • Ma, Chang-Sheng
  • Rothman, Kenneth J.
  • Lohmann, Ragna
  • Gurusamy, Venkatesh Kumar
  • Bartels, Dorothee B.
  • Lip, Gregory Y. H.
Type
Published Article
Journal
Clinical Research in Cardiology
Publisher
Springer Berlin Heidelberg
Publication Date
Mar 16, 2022
Volume
111
Issue
5
Pages
548–559
Identifiers
DOI: 10.1007/s00392-021-01957-1
PMID: 35294623
PMCID: PMC9054866
Source
PubMed Central
Keywords
Disciplines
  • Original Paper
License
Unknown

Abstract

Background Prospectively collected, routine clinical practice-based data on antithrombotic therapy in non-valvular atrial fibrillation (AF) patients are important for assessing real-world comparative outcomes. The objective was to compare the safety and effectiveness of dabigatran versus vitamin K antagonists (VKAs) in patients with newly diagnosed AF. Methods and results GLORIA-AF is a large, prospective, global registry program. Consecutive patients with newly diagnosed AF and CHA2DS2-VASc scores ≥ 1 were included and followed for 3 years. To control for differences in patient characteristics, the comparative analysis for dabigatran versus VKA was performed on a propensity score (PS)-matched patient set. Missing data were multiply imputed. Proportional-hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Between 2014 and 2016, 21,300 eligible patients were included worldwide: 3839 patients were prescribed dabigatran and 4836 VKA with a median age of 71.0 and 72.0 years, respectively; > 85% in each group had a CHA2DS2-VASc-score ≥ 2. The PS-matched comparative analysis for dabigatran and VKA included on average 3326 pairs of matched initiators. For dabigatran versus VKAs, adjusted HRs (95% confidence intervals) were: stroke 0.89 (0.59–1.34), major bleeding 0.61 (0.42–0.88), all-cause death 0.78 (0.63–0.97), and myocardial infarction 0.89 (0.53–1.48). Further analyses stratified by PS and region provided similar results. Conclusions Dabigatran was associated with a 39% reduced risk of major bleeding and 22% reduced risk for all-cause death compared with VKA. Stroke and myocardial infarction risks were similar, confirming a more favorable benefit-risk profile for dabigatran compared with VKA in clinical practice. Clinical trial registration https://www.clinicaltrials.gov . NCT01468701, NCT01671007. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01957-1.

Report this publication

Statistics

Seen <100 times