SwePub
Sök i LIBRIS databas

  Utökad sökning

WFRF:(Bohula Erin A.)
 

Sökning: WFRF:(Bohula Erin A.) > Direct Oral Anticoa...

  • Carnicelli, Anthony P.Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA. (författare)

Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation : Patient-Level Network Meta-Analyses of Randomized Clinical Trials With Interaction Testing by Age and Sex

  • Artikel/kapitelEngelska2022

Förlag, utgivningsår, omfång ...

  • Ovid Technologies (Wolters Kluwer Health),2022
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-481436
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-481436URI
  • https://doi.org/10.1161/CIRCULATIONAHA.121.056355DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Background: Direct oral anticoagulants (DOACs) are preferred over warfarin for stroke prevention in atrial fibrillation. Meta-analyses using individual patient data offer substantial advantages over study-level data.Methods: We used individual patient data from the COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation) database, which includes all patients randomized in the 4 pivotal trials of DOACs versus warfarin in atrial fibrillation (RE-LY [Randomized Evaluation of Long-Term Anticoagulation Therapy], ROCKET AF [Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation], ARISTOTLE [Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation], and ENGAGE AF-TIMI 48 [Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48]), to perform network meta-analyses using a stratified Cox model with random effects comparing standard-dose DOAC, lower-dose DOAC, and warfarin. Hazard ratios (HRs [95% CIs]) were calculated for efficacy and safety outcomes. Covariate-by-treatment interaction was estimated for categorical covariates and for age as a continuous covariate, stratified by sex.Results: A total of 71 683 patients were included (29 362 on standard-dose DOAC, 13 049 on lower-dose DOAC, and 29 272 on warfarin). Compared with warfarin, standard-dose DOACs were associated with a significantly lower hazard of stroke or systemic embolism (883/29 312 [3.01%] versus 1080/29 229 [3.69%]; HR, 0.81 [95% CI, 0.74-0.89]), death (2276/29 312 [7.76%] versus 2460/29 229 [8.42%]; HR, 0.92 [95% CI, 0.87-0.97]), and intracranial bleeding (184/29 270 [0.63%] versus 409/29 187 [1.40%]; HR, 0.45 [95% CI, 0.37-0.56]), but no statistically different hazard of major bleeding (1479/29 270 [5.05%] versus 1733/29 187 [5.94%]; HR, 0.86 [95% CI, 0.74-1.01]), whereas lower-dose DOACs were associated with no statistically different hazard of stroke or systemic embolism (531/13 049 [3.96%] versus 1080/29 229 [3.69%]; HR, 1.06 [95% CI, 0.95-1.19]) but a lower hazard of intracranial bleeding (55/12 985 [0.42%] versus 409/29 187 [1.40%]; HR, 0.28 [95% CI, 0.21-0.37]), death (1082/13 049 [8.29%] versus 2460/29 229 [8.42%]; HR, 0.90 [95% CI, 0.83-0.97]), and major bleeding (564/12 985 [4.34%] versus 1733/29 187 [5.94%]; HR, 0.63 [95% CI, 0.45-0.88]). Treatment effects for standard- and lower-dose DOACs versus warfarin were consistent across age and sex for stroke or systemic embolism and death, whereas standard-dose DOACs were favored in patients with no history of vitamin K antagonist use (P=0.01) and lower creatinine clearance (P=0.09). For major bleeding, standard-dose DOACs were favored in patients with lower body weight (P=0.02). In the continuous covariate analysis, younger patients derived greater benefits from standard-dose (interaction P=0.02) and lower-dose DOACs (interaction P=0.01) versus warfarin.Conclusions: Compared with warfarin, DOACs have more favorable efficacy and safety profiles among patients with atrial fibrillation.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Hong, HwanheeDuke Univ, Duke Clin Res Inst, Durham, NC USA.;Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA. (författare)
  • Connolly, Stuart J.McMaster Univ, Dept Med, Hamilton, ON, Canada.;Populat Hlth Res Inst, Hamilton, ON, Canada. (författare)
  • Eikelboom, JohnMcMaster Univ, Dept Med, Hamilton, ON, Canada.;Populat Hlth Res Inst, Hamilton, ON, Canada. (författare)
  • Giugliano, Robert P.Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.;Thrombolysis Myocardial Infarct Study Grp, Boston, MA USA. (författare)
  • Morrow, David A.Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.;Thrombolysis Myocardial Infarct Study Grp, Boston, MA USA. (författare)
  • Patel, Manesh R.Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA. (författare)
  • Wallentin, Lars,1943-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)larswall (författare)
  • Alexander, John H.Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA. (författare)
  • Cecilia Bahit, M.INECO Neurociencias Orono, Dept Cardiol, Santa Fe, Argentina. (författare)
  • Benz, Alexander P.Populat Hlth Res Inst, Hamilton, ON, Canada. (författare)
  • Bohula, Erin A.Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.;Thrombolysis Myocardial Infarct Study Grp, Boston, MA USA. (författare)
  • Chao, Tze-FanTaipei Vet Gen Hosp, Div Cardiol, Taipei, Taiwan. (författare)
  • Dyal, LeannePopulat Hlth Res Inst, Hamilton, ON, Canada. (författare)
  • Ezekowitz, MichaelLankenau Inst Med Res, Wynnewood, PA USA. (författare)
  • A.a. Fox, KeithUniv Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland. (författare)
  • Gencer, BarisGeneva Univ Hosp, Div Cardiol, Geneva, Switzerland.;Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland. (författare)
  • Halperin, Jonathan L.Mt Sinai Med Ctr, Cardiovasc Inst, New York, NY 10029 USA. (författare)
  • Hijazi, ZiadUppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi(Swepub:uu)ziahi940 (författare)
  • Hohnloser, Stefan H.Goethe Univ Frankfurt, Dept Cardiol, Frankfurt, Germany. (författare)
  • Hua, KaiyuanDuke Univ, Duke Clin Res Inst, Durham, NC USA.;Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA. (författare)
  • Hylek, ElaineBoston Univ, Dept Med, Sch Med, Boston, MA 02215 USA. (författare)
  • Toda Kato, EriKyoto Univ, Dept Cardiol, Kyoto, Japan. (författare)
  • Kuder, JuliaHarvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA. (författare)
  • Lopes, Renato D.Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA. (författare)
  • Mahaffey, Kenneth W.Stanford Univ, Sch Med, Dept Med, Stanford Ctr Clin Res, Stanford, CA 94305 USA. (författare)
  • Oldgren, Jonas,1964-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)jonaoldg (författare)
  • Piccini, Jonathan P.Duke Univ, Duke Clin Res Inst, Durham, NC USA. (författare)
  • Ruff, Christian T.Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA.;Thrombolysis Myocardial Infarct Study Grp, Boston, MA USA. (författare)
  • Steffel, JanUniv Zurich, Dept Cardiol, Zurich, Switzerland. (författare)
  • Wojdyla, DanielDuke Univ, Duke Clin Res Inst, Durham, NC USA. (författare)
  • Granger, Christopher B.Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA. (författare)
  • Duke Univ, Div Cardiol, Durham, NC USA.;Duke Univ, Duke Clin Res Inst, Durham, NC USA.Duke Univ, Duke Clin Res Inst, Durham, NC USA.;Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA. (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Circulation: Ovid Technologies (Wolters Kluwer Health)145:4, s. 242-2550009-73221524-4539

Internetlänk

Hitta via bibliotek

Till lärosätets databas

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy