https://scholars.lib.ntu.edu.tw/handle/123456789/435530
標題: | Dabigatran, Rivaroxaban, and Warfarin in the Oldest Adults with Atrial Fibrillation in Taiwan | 作者: | CHAO LUN LAI Chen, Ho-Min MIN-TSUN LIAO TING TSE LIN |
關鍵字: | dabigatran; effectiveness; octogenarian; rivaroxaban; safety; warfarin | 公開日期: | 2018 | 卷: | 66 | 期: | 8 | 起(迄)頁: | 1567-1574 | 來源出版物: | Journal of the American Geriatrics Society | 摘要: | Objectives: To compare the effectiveness and safety of reduced-dose dabigatran, reduced-dose rivaroxaban, and warfarin in individuals aged 85 and older with atrial fibrillation (AF). Design: Retrospective cohort study. Setting: Taiwan National Health Insurance claims database, 2011?2015. Participants: Individuals with AF aged 85 and older (mean 88.6) with incident use of oral anticoagulants between June 1, 2012 and May 31, 2015 (N=4,722; dabigatran 110 mg, n=1,489; rivaroxaban 15 mg/10 mg, n=1,736; warfarin, n=1,497). Measurements: Clinical outcomes included all-cause death, cardiovascular death, ischemic stroke, acute myocardial infarction, arterial embolism or thrombosis, intracranial hemorrhage, and gastrointestinal hemorrhage needing transfusion. Propensity score–matched analysis was performed, and the marginal proportional hazards model was used to estimate the relative risk of various clinical outcomes in a matched dabigatran-warfarin cohort (n=1,180 in each group) and a rivaroxaban-warfarin cohort (n=1,207 in each group). Results: Mean follow-up was 6.6 months for the overall population. Dabigatran group participants had lower risks of all-cause death (hazard ratio (HR)=0.59, 95% confidence interval (CI)=0.45–0.77) and cardiovascular death (HR=0.45, 95% CI=0.30–0.68) than warfarin group participants. Rivaroxaban users also had lower risks of all-cause death (HR=0.61, 95% CI=0.47–0.79) and cardiovascular death (HR=0.52, 95% CI=0.35–0.75) than warfarin users. Dabigatran users also had a lower risk of intracranial hemorrhage than warfarin users (HR=0.31, 95% CI=0.10–0.97). Conclusion: Individuals with AF aged 85 and older who used reduced-dose dabigatran or reduced-dose rivaroxaban had statistically significantly lower all-cause mortality and cardiovascular mortality than those who used warfarin. Reduced-dose dabigatran was also associated with lower risk of intracranial hemorrhage than warfarin. ? 2018, Copyright the Authors Journal compilation ? 2018, The American Geriatrics Society |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85050379702&doi=10.1111%2fjgs.15430&partnerID=40&md5=a6751b00e9b612c6cd8fb05ec146e782 https://scholars.lib.ntu.edu.tw/handle/123456789/435530 |
DOI: | 10.1111/jgs.15430 | SDG/關鍵字: | dabigatran; rivaroxaban; warfarin; anticoagulant agent; dabigatran; rivaroxaban; warfarin; aged; anticoagulant therapy; artery embolism; artery thrombosis; Article; atrial fibrillation; brain hemorrhage; cardiovascular mortality; cause of death; clinical outcome; cohort analysis; comparative effectiveness; controlled study; drug dose reduction; drug safety; follow up; human; incidence; major clinical study; retrospective study; risk factor; Taiwan; very elderly; atrial fibrillation; factual database; female; male; mortality; proportional hazards model; public health; treatment outcome; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Dabigatran; Databases, Factual; Female; Humans; Male; National Health Programs; Proportional Hazards Models; Retrospective Studies; Rivaroxaban; Taiwan; Treatment Outcome; Warfarin |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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