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Outcomes for Atrial Fibrillation Similar With Dabigatran, Warfarin

Ischemic stroke, extracranial bleeding rates similar; lower risk of intracranial bleeding with dabigatran


TUESDAY, Nov. 14, 2017 (HealthDay News) -- In clinical practice, patients starting dabigatran therapy do not have significantly different rates of ischemic stroke or extracranial hemorrhage than those starting warfarin therapy, though they have lower rates of intracranial bleeding, according to a study published online Nov. 13 in the Annals of Internal Medicine.

Alan S. Go, M.D., from Kaiser Permanente Northern California in Oakland, and colleagues performed a retrospective cohort study to compare incidence of stroke, bleeding, and myocardial infarction in patients with atrial fibrillation initiating dabigatran or warfarin (n = 25,289 for each) from November 2010 to May 2014.

The researchers found that those receiving dabigatran did not have significantly different rates of ischemic stroke (hazard ratio [HR], 0.92; 95 percent confidence interval [CI], 0.65 to 1.28) or extracranial hemorrhage (HR, 0.89; 95 percent CI, 0.72 to 1.09). However, those initiating dabigatran were less likely to have intracranial bleeding (HR, 0.51; 95 percent CI, 0.33 to 0.79). They were also more likely to have myocardial infarction (HR, 1.88; 95 percent CI, 1.22 to 2.9), but the strength and significance of this association varied in sensitivity analyses and by exposure definition (HR range, 1.13 [95 percent CI, 0.78 to 1.64] to 1.43 [95 percent CI, 0.99 to 2.08). Higher gastrointestinal bleeding rates with dabigatran were seen among older patients and those with kidney disease.

"In matched adults with atrial fibrillation treated in practice, the incidences of stroke and bleeding with dabigatran versus warfarin were consistent with those seen in trials," conclude the authors.

Several authors disclosed financial ties to the pharmaceutical industry.

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