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Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation

Open access
Yao, Xiaoxi, Abraham, Neena S., Sangaralingham, Lindsey R., Bellolio, M. Fernanda, McBane, Robert D., Shah, Nilay D., Noseworthy, Peter A.·2016·Journal of the American Heart Association

Abstract

Background: The introduction of non–vitamin K antagonist oral anticoagulants has been a major advance for stroke prevention in atrial fibrillation; however, outcomes achieved in clinical trials may not translate to routine practice. We aimed to evaluate the effectiveness and safety of dabigatran, rivaroxaban, and apixaban by comparing each agent with warfarin. Methods and Results: Using a large US insurance database, we identified privately insured and Medicare Advantage patients with nonvalvular atrial fibrillation who were users of apixaban, dabigatran, rivaroxaban, or warfarin between October 1, 2010, and June 30, 2015. We created 3 matched cohorts using 1:1 propensity score matching: apixaban versus warfarin (n=15 390), dabigatran versus warfarin (n=28 614), and rivaroxaban versus warfarin (n=32 350). Using Cox proportional hazards regression, we found that for stroke or systemic embolism, apixaban was associated with lower risk (hazard ratio [ HR ] 0.67, 95% CI 0.46–0.98, P =0.04), but dabigatran and rivaroxaban were associated with a similar risk (dabigatran: HR 0.98, 95% CI 0.76–1.26, P =0.98; rivaroxaban: HR 0.93, 95% CI 0.72–1.19, P =0.56). For major bleeding, apixaban and dabigatran were associated with lower risk (apixaban: HR 0.45, 95% CI 0.34–0.59, P <0.001; dabigatran: HR 0.79, 95% CI 0.67–0.94, P <0.01), and rivaroxaban was associated with a similar risk ( HR 1.04, 95% CI 0.90–1.20], P =0.60). All non–vitamin K antagonist oral anticoagulants were associated with a lower risk of intracranial bleeding. Conclusions: In patients with nonvalvular atrial fibrillation, apixaban was associated with lower risks of both stroke and major bleeding, dabigatran was associated with similar risk of stroke but lower risk of major bleeding, and rivaroxaban was associated with similar risks of both stroke and major bleeding in comparison to warfarin.

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Metadata

Authors
Yao, X., Abraham, N. S., Sangaralingham, L. R., Bellolio, M. F., McBane, R. D., Shah, N. D., & Noseworthy, P. A.
Venue
Journal of the American Heart Association
Published
2016-06-13
Volume
5
Issue
6
ISSN
2047-9980 (ISSN-L)
OpenAlex
W2433454023
Cited by
419
References
67
FWCI
56.28
Type
journal article
Language
en
Open access
gold

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CoChat. (2026). Citation check: Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation. https://app.cochat.ai/papers/10.1161/jaha.116.003725
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Yao, X., Abraham, N. S., Sangaralingham, L. R., Bellolio, M. F., McBane, R. D., Shah, N. D., & Noseworthy, P. A. (2016). Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation. Journal of the American Heart Association. https://doi.org/10.1161/jaha.116.003725

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