Newly Diagnosed Atrial Fibrillation Benefits From Rivaroxaban, Dabigatran

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Rivaroxaban reduced risk of acute MI admission, but only in men.
Rivaroxaban reduced risk of acute MI admission, but only in men.

In patients with newly diagnosed atrial fibrillation (AF), direct oral anticoagulation reduced the risk for congestive heart failure hospitalizations and all-cause mortality in both men and women, according to research presented at the Heart Rhythm Society's 38th Annual Scientific Sessions, May 10-13, in Chicago, Illinois.

The study cohort (n=65,734 men; n=81,137 women) consisted of Medicare Part D beneficiaries who were ≥66 years of age and initiated on anticoagulation (rivaroxaban 20 mg once daily, dabigatran twice daily, or warfarin) within 90 days of AF diagnosis.

The researchers compared inpatient admissions for acute myocardial infarction (AMI), congestive heart failure, and all-cause mortality after anticoagulation initiation across the 3 drugs in both men and women using 3-way propensity-matched samples.

In men, rivaroxaban reduced the risk for admission for AMI (hazard ratio [HR] 0.59; 95% CI, 0.38-0.91; P =.018) and congestive heart failure (HR 0.76; 95% CI, 0.64-0.91; P =.002), as well as all-cause mortality (HR 0.61; 95% CI, 0.49-0.75; P <.001) compared with warfarin.

While dabigatran reduced the risk for congestive heart failure (HR 0.83; 95% CI, 0.69-0.98; P =.033) and all-cause mortality (HR 0.71; 95% CI, 0.58-0.87; P =.001) in men, it was associated with a similar risk for AMI admissions compared with warfarin.

When both direct oral anticoagulants were compared, rivaroxaban was associated with a reduced risk for AMI admission (HR 0.57; 95% CI, 0.31-0.89; P =.012) compared with dabigatran, as well as a similar risk for congestive heart failure admission and all-cause mortality in men.

In women, however, the risk of AMI admission was similar across all 3 drugs. Rivaroxaban and dabigatran did reduce the risk for congestive heart failure admission and all-cause mortality compared with warfarin, but there were no differences between the 2 agents in congestive heart failure admissions or all-cause mortality.

“Use of [direct oral anticoagulants] when compared [with] warfarin use reduced the risk of [congestive heart failure] hospitalizations and all-cause mortality in both genders. However, reduced risk of AMI noted with [rivaroxaban] use appears to be limited to men,” the researchers concluded.

Reference

Shantha GPS, Dandamudi G, Sirgurdsson G, et al. Gender specific associations of oral anticoagulant use and risk of acute myocardial infarction, congestive heart failure, and all-cause mortality in patients with newly diagnosed atrial fibrillation. Presented at: Heart Rhythm Society's 38th Annual Scientific Sessions. May 10-13, 2017; Chicago, Illinois.

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