Real-world on-treatment and initial treatment absolute risk differences for dabigatran vs warfarin in older US adults.
Age Factors
Aged
Aged, 80 and over
Antithrombins
/ adverse effects
Atrial Fibrillation
/ drug therapy
Dabigatran
/ adverse effects
Drug-Related Side Effects and Adverse Reactions
Female
Gastrointestinal Hemorrhage
/ epidemiology
Health Services for the Aged
Humans
Male
Medicare
Risk Factors
Stroke
/ mortality
United States
/ epidemiology
Warfarin
/ adverse effects
anticoagulants
atrial fibrillation
dabigatran
older adults
stroke
Journal
Pharmacoepidemiology and drug safety
ISSN: 1099-1557
Titre abrégé: Pharmacoepidemiol Drug Saf
Pays: England
ID NLM: 9208369
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
15
11
2019
revised:
05
05
2020
accepted:
01
06
2020
pubmed:
16
7
2020
medline:
16
6
2021
entrez:
16
7
2020
Statut:
ppublish
Résumé
Trials and past observational work compared dabigatran and warfarin in patients with atrial fibrillation, but few reported estimates of absolute harm and benefit under real-world adherence patterns, particularly in older adults that may have differing benefit-harm profiles. We aimed to estimate risk differences for ischemic stroke, death, and gastrointestinal bleeding after initiating dabigatran and warfarin in older adults (a) when patients adhere to treatment and (b) under real-world adherence patterns. In a 20% sample of nationwide Medicare claims from 2010 to 2015, we identified beneficiaries aged 66 years and older initiating warfarin and dabigatran. We followed individuals from initiation until death or October 2015 (initial treatment, IT) and separately censored individuals' follow-up after drug switches and gaps in supply (on-treatment, OT). We applied inverse probability of treatment and standardized morbidity ratio weights, as well as inverse probability of censoring weights, to estimate two-year risk differences (RDs) for dabigatran vs warfarin. We identified 10,717 dabigatran and 74,891 warfarin initiators. Weighted OT RDs suggested decreased ischemic stroke risk for dabigatran vs warfarin; IT RDs indicated increased or no change in ischemic stroke risk. Regardless of follow-up approach and weighting strategy, risk of death appeared lower and risk of gastrointestinal bleeding appeared higher when comparing dabigatran vs warfarin. Dabigatran use was associated with lower risks of mortality and ischemic stroke in routine care when older adults stayed on treatment. IT analyses suggested that these benefits may be diminished under real-world patterns of switching and discontinuation.
Identifiants
pubmed: 32666678
doi: 10.1002/pds.5069
pmc: PMC8356559
mid: NIHMS1727195
doi:
Substances chimiques
Antithrombins
0
Warfarin
5Q7ZVV76EI
Dabigatran
I0VM4M70GC
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
832-841Subventions
Organisme : NIH HHS
ID : UL1TR002489
Pays : United States
Organisme : NIH HHS
ID : K01AI125087
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002489
Pays : United States
Organisme : NIAID NIH HHS
ID : K01 AI125087
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG056479
Pays : United States
Informations de copyright
© 2020 John Wiley & Sons Ltd.
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