TY - JOUR
T1 - Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice
T2 - GLORIA-AF Registry
AU - Lip, Gregory Y.H.
AU - Kotalczyk, Agnieszka
AU - Teutsch, Christine
AU - Diener, Hans Christoph
AU - Dubner, Sergio J.
AU - Halperin, Jonathan L.
AU - Ma, Chang Sheng
AU - Rothman, Kenneth J.
AU - Marler, Sabrina
AU - Gurusamy, Venkatesh Kumar
AU - Huisman, Menno V.
AU - Abban, Dzifa Wosornu
AU - Aziz, Emad
AU - Kalan, Marica Bracic
AU - Abdul, Nasser
AU - Backes, Luciano Marcelo
AU - Bradman, Drew
AU - Abud, Atilio Marcelo
AU - Badings, E.
AU - Brautigam, Donald
AU - Adams, Fran
AU - Bagni, Ermentina
AU - Breton, Nicolas
AU - Addala, Srinivas
AU - Baker, Seth H.
AU - Brouwers, P. J.A.M.
AU - Adragão, Pedro
AU - Bala, Richard
AU - Browne, Kevin
AU - Ageno, Walter
AU - Baldi, Antonio
AU - Cortada, Jordi Bruguera
AU - Aggarwal, Rajesh
AU - Bando, Shigenobu
AU - Bruni, A.
AU - Agosti, Sergio
AU - Banerjee, Subhash
AU - Brunschwig, Claude
AU - Agostoni, Piergiuseppe
AU - Bank, Alan
AU - Buathier, Hervé
AU - Aguilar, Francisco
AU - Esquivias, Gonzalo Barón
AU - Buhl, Aurélie
AU - Linares, Julio Aguilar
AU - Barr, Craig
AU - Bullinga, John
AU - Aguinaga, Luis
AU - Davis, Gershan
AU - Williams, David
AU - the GLORIA-AF Investigators
N1 - © 2022. The Author(s).
PY - 2022/3/16
Y1 - 2022/3/16
N2 - BACKGROUND AND PURPOSE: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF).METHODS: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest.RESULTS: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79-2.03), major bleeding 0.59 (0.40-0.88), myocardial infarction 0.68 (0.40-1.16), and all-cause death 0.86 (0.67-1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76-1.78), myocardial infarction 0.84 (0.48-1.46), major bleeding 0.98 (0.63-1.52) and all-cause death 1.01 (0.79-1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52-1.19), myocardial infarction 0.96 (0.63-1.45), major bleeding 1.54 (1.14-2.08), and all-cause death 0.97 (0.80-1.19).CONCLUSIONS: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death.REGISTRATION: URL: https://www.CLINICALTRIALS: gov . Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013.
AB - BACKGROUND AND PURPOSE: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF).METHODS: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest.RESULTS: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79-2.03), major bleeding 0.59 (0.40-0.88), myocardial infarction 0.68 (0.40-1.16), and all-cause death 0.86 (0.67-1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76-1.78), myocardial infarction 0.84 (0.48-1.46), major bleeding 0.98 (0.63-1.52) and all-cause death 1.01 (0.79-1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52-1.19), myocardial infarction 0.96 (0.63-1.45), major bleeding 1.54 (1.14-2.08), and all-cause death 0.97 (0.80-1.19).CONCLUSIONS: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death.REGISTRATION: URL: https://www.CLINICALTRIALS: gov . Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013.
KW - Administration, Oral
KW - Anticoagulants/adverse effects
KW - Atrial Fibrillation/complications
KW - Clinical Trials, Phase III as Topic
KW - Dabigatran/adverse effects
KW - Hemorrhage/chemically induced
KW - Humans
KW - Myocardial Infarction/complications
KW - Prospective Studies
KW - Pyridones/adverse effects
KW - Registries
KW - Rivaroxaban/adverse effects
KW - Stroke/epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85126339162&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126339162&partnerID=8YFLogxK
UR - https://link.springer.com/article/10.1007/s00392-022-02021-2
U2 - 10.1007/s00392-022-01996-2
DO - 10.1007/s00392-022-01996-2
M3 - Article (journal)
C2 - 35294625
AN - SCOPUS:85126339162
SN - 1861-0684
VL - 111
SP - 560
EP - 573
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 5
ER -