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DOACs associated with lower mortality in comparison to Warfarin, Finds study
Among US nursing home residents, the direct-acting oral anticoagulants (DOACs) were each associated with lower mortality versus warfarin, according to recent research published in the Journal of General Internal Medicine.
"Misaligned DOAC dosing was common in nursing homes and was associated with clinical and mortality outcomes", exclaims Matthew Alcusky, the lead author from the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Research comparing direct-acting oral anticoagulants (DOACs) to warfarin has excluded nursing home residents, a vulnerable and high-risk population. Therefore, the researchers carried out this study to compare the safety and effectiveness of DOACs versuswarfarin.
This new-user cohort study went on from 2011-2016 where US nursing home residents aged > 65 years with non-valvular atrial fibrillation were enrolled in fee-for-service Medicare for > 6 months. The initiators of DOACs (2881 apixaban, 1289 dabigatran, 3735 rivaroxaban) were 1:1 propensity-matched to warfarin initiators.
The main measures included ischemic stroke or transient ischemic attack (i.e., ischemic cerebrovascular event), bleeding (extracranial or intracranial), other vascular events, death, and a composite of all outcomes. Also, absolute rate differences (RD) and cause-specific hazard ratios (HR) with 95% confidence intervals (CI) were estimated. Subgroup analyses were performed by the alignment of DOAC dosing with labeling.
Based on the methodology, the main outcome observed by Alcusky and his colleagues was that the clinical outcome rates for dabigatran and rivaroxaban users were similar versus warfarin users.
On the other hand, the ischemic cerebrovascular event rates were higher among dabigatran and rivaroxaban users that received reduced dosages without an indication. And the overall apixaban users had higher ischemic cerebrovascular event rates and lower bleeding rates but outcome rates varied by dosing alignment.
To highlight the mortality risk, it was noted that the "Mortality rates (per 100 person-years) were lower for apixaban (RDs - 9.30; 95% CI - 13.18 to - 5.42), dabigatran (RDs - 10.79; 95% CI - 14.98 to - 6.60), and rivaroxaban (RDs - 8.92; 95% CI - 12.01 to - 5.83) versus warfarin; however composite outcome findings were similar."
Hence the authors drew the following conclusion-
"Among US nursing home residents, the DOACs were each associated with lower mortality versus warfarin. Misaligned DOAC dosing was common in nursing homes and was associated with clinical and mortality outcomes. Overall, DOAC users had lower rates of adverse outcomes including mortality compared with warfarin users."
BDS, MDS( Pedodontics and Preventive Dentistry)
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
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