Bleeding risk of apixaban, dabigatran, and low-dose rivaroxaban compared with warfarin in Japanese patients with non-valvular atrial fibrillation: a propensity matched analysis of administrative claims data

Shun Kosaka, Tatsunori Murata, Naoko Izumi, Jun Katada, Feng Wang, Yasuo Terayama

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives: There is scarce evidence comparing novel oral anticoagulants (NOACs) with warfarin in real-world settings in Japan. This study compared the risk of bleeding events among patients with non-valvular atrial fibrillation (NVAF) initiating treatment with NOACs versus warfarin. Methods: A retrospective cohort study was conducted using a de-identified electronic health record based database of health claims and Diagnosis Procedure Combination data from 275 consenting hospitals in Japan. NVAF patients newly initiated on oral anticoagulants were eligible. Based on the first prescription, patients were assigned to 5/2.5 mg BID apixaban, 150/110 mg BID dabigatran, 15/10 mg QD rivaroxaban (approved dose lower in Japan compared to Western countries [20/15 mg QD]) or warfarin groups. One-to-one propensity score matching (PSM) was used to balance patient characteristics between warfarin and each NOAC. Patients were followed up to 1 year post-first prescription. Results: Among 38,662 eligible patients, a total of 5977, 5090, and 6726 matched pairs were identified for warfarin versus apixaban, warfarin versus dabigatran, and warfarin versus rivaroxaban, respectively after PSM. Compared to warfarin, apixaban (hazard ratio [HR] 0.586; 95% CI 0.421–0.815), dabigatran (HR 0.617; 0.425–0.895) and rivaroxaban (HR 0.693; 0.514–0.933) were associated with a significantly lower risk of major bleeding. The risk of any bleeding was significantly lower for apixaban (HR 0.782; 0.682–0.896), but not for dabigatran (HR 0.988; 0.860–1.135) or rivaroxaban (HR 0.938; 0.832–1.057) when comparing to warfarin. Conclusions: Among Japanese patients with NVAF, treatment with apixaban 5/2.5 mg BID was associated with a significantly lower risk of major bleeding and any bleeding when compared to warfarin. Treatment with dabigatran 150/110 mg BID or rivaroxaban 15/10 mg QD was associated with a significantly lower risk of major bleeding, but not any bleeding, than warfarin. The potential benefit of individual NOACs in real-world practice needs to be assessed further.

Original languageEnglish
Pages (from-to)1955-1963
Number of pages9
JournalCurrent Medical Research and Opinion
Volume33
Issue number11
DOIs
Publication statusPublished - 2017 Nov 2

Fingerprint

Insurance Claim Review
Warfarin
Atrial Fibrillation
Hemorrhage
Anticoagulants
Propensity Score
Japan
Prescriptions
Rivaroxaban
Dabigatran
apixaban
Electronic Health Records
Cohort Studies

Keywords

  • apixaban
  • Bleeding
  • dabigatran
  • nonvalvular atrial filtration
  • novel oral anticoagulants
  • rivaroxaban
  • warfarin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bleeding risk of apixaban, dabigatran, and low-dose rivaroxaban compared with warfarin in Japanese patients with non-valvular atrial fibrillation : a propensity matched analysis of administrative claims data. / Kosaka, Shun; Murata, Tatsunori; Izumi, Naoko; Katada, Jun; Wang, Feng; Terayama, Yasuo.

In: Current Medical Research and Opinion, Vol. 33, No. 11, 02.11.2017, p. 1955-1963.

Research output: Contribution to journalArticle

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abstract = "Objectives: There is scarce evidence comparing novel oral anticoagulants (NOACs) with warfarin in real-world settings in Japan. This study compared the risk of bleeding events among patients with non-valvular atrial fibrillation (NVAF) initiating treatment with NOACs versus warfarin. Methods: A retrospective cohort study was conducted using a de-identified electronic health record based database of health claims and Diagnosis Procedure Combination data from 275 consenting hospitals in Japan. NVAF patients newly initiated on oral anticoagulants were eligible. Based on the first prescription, patients were assigned to 5/2.5 mg BID apixaban, 150/110 mg BID dabigatran, 15/10 mg QD rivaroxaban (approved dose lower in Japan compared to Western countries [20/15 mg QD]) or warfarin groups. One-to-one propensity score matching (PSM) was used to balance patient characteristics between warfarin and each NOAC. Patients were followed up to 1 year post-first prescription. Results: Among 38,662 eligible patients, a total of 5977, 5090, and 6726 matched pairs were identified for warfarin versus apixaban, warfarin versus dabigatran, and warfarin versus rivaroxaban, respectively after PSM. Compared to warfarin, apixaban (hazard ratio [HR] 0.586; 95{\%} CI 0.421–0.815), dabigatran (HR 0.617; 0.425–0.895) and rivaroxaban (HR 0.693; 0.514–0.933) were associated with a significantly lower risk of major bleeding. The risk of any bleeding was significantly lower for apixaban (HR 0.782; 0.682–0.896), but not for dabigatran (HR 0.988; 0.860–1.135) or rivaroxaban (HR 0.938; 0.832–1.057) when comparing to warfarin. Conclusions: Among Japanese patients with NVAF, treatment with apixaban 5/2.5 mg BID was associated with a significantly lower risk of major bleeding and any bleeding when compared to warfarin. Treatment with dabigatran 150/110 mg BID or rivaroxaban 15/10 mg QD was associated with a significantly lower risk of major bleeding, but not any bleeding, than warfarin. The potential benefit of individual NOACs in real-world practice needs to be assessed further.",
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T1 - Bleeding risk of apixaban, dabigatran, and low-dose rivaroxaban compared with warfarin in Japanese patients with non-valvular atrial fibrillation

T2 - a propensity matched analysis of administrative claims data

AU - Kosaka, Shun

AU - Murata, Tatsunori

AU - Izumi, Naoko

AU - Katada, Jun

AU - Wang, Feng

AU - Terayama, Yasuo

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N2 - Objectives: There is scarce evidence comparing novel oral anticoagulants (NOACs) with warfarin in real-world settings in Japan. This study compared the risk of bleeding events among patients with non-valvular atrial fibrillation (NVAF) initiating treatment with NOACs versus warfarin. Methods: A retrospective cohort study was conducted using a de-identified electronic health record based database of health claims and Diagnosis Procedure Combination data from 275 consenting hospitals in Japan. NVAF patients newly initiated on oral anticoagulants were eligible. Based on the first prescription, patients were assigned to 5/2.5 mg BID apixaban, 150/110 mg BID dabigatran, 15/10 mg QD rivaroxaban (approved dose lower in Japan compared to Western countries [20/15 mg QD]) or warfarin groups. One-to-one propensity score matching (PSM) was used to balance patient characteristics between warfarin and each NOAC. Patients were followed up to 1 year post-first prescription. Results: Among 38,662 eligible patients, a total of 5977, 5090, and 6726 matched pairs were identified for warfarin versus apixaban, warfarin versus dabigatran, and warfarin versus rivaroxaban, respectively after PSM. Compared to warfarin, apixaban (hazard ratio [HR] 0.586; 95% CI 0.421–0.815), dabigatran (HR 0.617; 0.425–0.895) and rivaroxaban (HR 0.693; 0.514–0.933) were associated with a significantly lower risk of major bleeding. The risk of any bleeding was significantly lower for apixaban (HR 0.782; 0.682–0.896), but not for dabigatran (HR 0.988; 0.860–1.135) or rivaroxaban (HR 0.938; 0.832–1.057) when comparing to warfarin. Conclusions: Among Japanese patients with NVAF, treatment with apixaban 5/2.5 mg BID was associated with a significantly lower risk of major bleeding and any bleeding when compared to warfarin. Treatment with dabigatran 150/110 mg BID or rivaroxaban 15/10 mg QD was associated with a significantly lower risk of major bleeding, but not any bleeding, than warfarin. The potential benefit of individual NOACs in real-world practice needs to be assessed further.

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KW - apixaban

KW - Bleeding

KW - dabigatran

KW - nonvalvular atrial filtration

KW - novel oral anticoagulants

KW - rivaroxaban

KW - warfarin

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