Effectiveness and Safety in Patients with Non-Valvular Atrial Fibrillation Who Switched from Warfarin to Direct Oral Anticoagulants in Medicare Population
Research article published in Advances in therapy (2025)
Resumen
INTRODUCTION: Atrial fibrillation (AF), a common heart rhythm abnormality, is linked to a higher risk of stroke. Traditionally, warfarin has been the primary anticoagulation treatment for reducing the stroke risk. The new standard of treatment by direct oral anticoagulants (DOACs) offers greater benefits including improved efficacy and fewer adverse effects with reduced monitoring. This study aims to evaluate the risk of stroke/systemic embolism (SE) and major bleeding (MB) among patients with AF who switched from warfarin to DOACs. METHODS: This study utilized Medicare data to conduct a retrospective analysis of patients with non-valvular atrial fibrillation (NVAF) who switched from warfarin to DOACs between January 1, 2012, and December 31, 2019. Patients with NVAF aged 65 and older who switched from warfarin and had continuous health plan enrollment were included. Descriptive statistics, propensity score matching (PSM), and Cox proportional hazard (PH) models were utilized to compare the outcomes and assess risks of SE and MB across the DOAC cohorts. RESULTS: Among 1,843,495 patients with NVAF on warfarin, 171,700 switched to DOACs within 90 days of discontinuation (apixaban: 90,850; rivaroxaban: 67,698; dabigatran: 12,900). The mean follow-up period across DOAC cohorts ranged from 552 to 628 days. After PSM, apixaban showed significantly lower rates of stroke/SE compared to dabigatran (2.99% vs. 3.98%, p < 0.0001) and rivaroxaban (3.08% vs. 3.80%, p < 0.0001). MB rates were also lower with apixaban versus dabigatran (4.29% vs. 5.57%, p < 0.0001) and rivaroxaban (4.07% vs. 6.35%, p < 0.0001). Cox PH models confirmed these findings, with apixaban demonstrating lower risks of stroke/SE [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.72-0.96 vs. dabigatran; HR 0.91, 95% CI 0.85-0.96 vs. rivaroxaban] and MB (HR 0.79, 95% CI 0.71-0.89 vs. dabigatran; HR 0.68, 95% CI 0.65-0.72 vs. rivaroxaban). CONCLUSION: The risk of stroke/SE and MB varies significantly among patients with NVAF switching from warfarin to different DOACs, with apixaban presenting the lowest risk compared to dabigatran and rivaroxaban.
Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.
El resumen se deja sin traducir para conservar la redacción original de los autores.
Síntesis
Among 171,700 Medicare patients with non-valvular atrial fibrillation who switched from warfarin to a direct oral anticoagulant, propensity-matched analysis found lower stroke/systemic embolism and major bleeding rates with apixaban than with dabigatran or rivaroxaban.
Por qué esto importa para la hirudoterapia
Este cohorte retrospectivo de Medicare analizó a 171.700 pacientes con fibrilación auricular no valvular que cambiaron de warfarina a un DOAC (2012-2019); después del emparejamiento por puntaje de propensión, la apixaban se asoció con tasas significativamente menores de ictus/SE y sangrado mayor que dabigatran y rivaroxaban (p. ej., ictus/SE HR 0,83 vs dabigatran, 0,91 vs rivaroxaban), lo que llevó a los autores a concluir que el riesgo varía de manera significativa entre los DOAC, con la apixaban siendo la más baja. En cuanto a la hirudoterapia, el vínculo es mecanístico y comparativo: dabigatran es un inhibidor directo de la trombina oral que actúa sobre la misma diana de trombina que la hirudina de la sanguijuela, aunque no se deriva de ella, y el estudio ayuda a establecer un punto de referencia para esa clase frente a los inhibidores del Factor Xa. Nota: esto es investigación de datos de reclamaciones observacional sobre anticoagulantes sintéticos — no evalúa ni sanguijuelas medicinales ni agentes derivados de la hirudina — y la confusión residual significa que las diferencias comparativas son asociaciones, no una prueba de causalidad.
Compuestos relacionados del registro de la ASH
Fármacos sintéticos relacionados con el tema de este artículo. Actúan sobre las mismas dianas que las moléculas de la sanguijuela, pero no se derivan de la sanguijuela:
Citación
Effectiveness and Safety in Patients with Non-Valvular Atrial Fibrillation Who Switched from Warfarin to Direct Oral Anticoagulants in Medicare Population.
Atreja et al. · Advances in therapy, 2025
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Añadido a la biblioteca ASH: 29 de mayo de 2026 · Última actualización del sitio: 18 de junio de 2026