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  • Apixaban safer than...

Apixaban safer than other options for long-term anticoagulation among the elderly with AF

Written By : Aditi |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-04-15T09:30:25+05:30  |  Updated On 18 Oct 2023 4:56 PM IST
Apixaban safer than other options for long-term anticoagulation among the elderly with AF
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According to an Original Investigation on Cardiology published in JAMA Network Open entitled, "Comparative Effectiveness and Safety of Oral Anticoagulants by Dementia Status in Older Patients With Atrial Fibrillation”, researchers have concluded This is the first study to examine the relationship between sleep bruxism and mortality. The association between sleep bruxism and increased risk of mortality did not hold when the regression model was adjusted for known risk factors for mortality. Sleep bruxism is not a disease that kills but rather reflects a masticatory muscle behavior detrimental to health. apixaban usage is supported in dementia patients having Atrial fibrillation (AF).

It is already known that developing an optimal stroke prevention strategy, including OAC or oral anticoagulant therapy, is essential for AF patients living with dementia; it is a condition associated with an increased risk of adverse outcomes. There needs to be more data in this context.

To investigate this background further, a team of researchers did a comparative effectiveness study of 1 160 462 patients with AF with and without dementia.

The researchers drew the following conclusion from the study:

  • Apixaban has net clinical benefits compared with other OACs and more significant absolute risk reduction with vs without dementia patients aged 65 years or older with AF.
  • Three comparative new-user cohorts were warfarin vs apixaban, dabigatran vs apixaban and rivaroxaban vs apixaban.
  • Among dementia patients, compared with apixaban users, a higher rate of the composite endpoint was observed in warfarin users (95.7 events vs 64.2 events per 1000 PYs), dabigatran users (84.5 events vs 54.9 events per 1000 PYs) and rivaroxaban users (87.4 events vs 68.5 events per 1000 PYs) with an adjusted hazard ratio of 1.5, 1.5 and 1.3 respectively.
  • The magnitude of the benefits associated with apixaban was similar regardless of dementia diagnosis on the HR scale but differed substantially on the rate difference (RD) scale.
  • The adjusted RD of the composite outcome per 1000 PYs for warfarin vs apixaban users was 29.8 events in dementia patients vs 16.0 events without dementia.
  • The corresponding adjusted RD estimates of the composite outcome per 1000 PYs were 29.6 events in dementia patients vs 5.8 events in patients without dementia for dabigatran vs apixaban users and 20.5 events in dementia patients vs 15.9 events in patients without dementia for rivaroxaban vs apixaban users.
  • There was a more distinct pattern for significant bleeding than for ischemic stroke.

They said, “Apixaban was associated with lower rates of bleeding and ischemic stroke.”

The researchers reported that increased absolute risks associated with other OACs compared with apixaban was higher in dementia patients than those without dementia, particularly for significant bleeding.

The findings of our study support apixaban for anticoagulation therapy in dementia patients who have AF.

The study’s strength includes large nationally representative databases of older adults in the US.

The limitations of the study are misclassified subgroups and unmeasured confounding.

Further reading:

Lin KJ, Singer DE, Bykov K, et al. Comparative Effectiveness and Safety of Oral Anticoagulants by Dementia Status in Older Patients With Atrial Fibrillation. JAMA Netw Open. 2023;6(3):e234086.doi:10.1001/jamanetworkopen.2023.4086

ApixabanAFAtrial fibrilationJAMA Network Openoral anticoagulant therapyOACdementiaDabigatranwarfarinrivaroxabanwarfarin vs apixabendabigatran vs apixabanrivaroxaban vs apixabanoral anticoagulantsbleedingIschemic stroke
Source : JAMA Network Open
Aditi
Aditi

    BDS, MDS in Periodontics and Implantology

    Dr. Aditi Yadav is a BDS, MDS in Periodontics and Implantology. She has a clinical experience of 5 years as a laser dental surgeon. She also has a Diploma in clinical research and pharmacovigilance and is a Certified data scientist. She is currently working as a content developer in e-health services. Dr. Yadav has a keen interest in Medical Journalism and is actively involved in Medical Research writing.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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