Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: A nationwide cohort study

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Abstract

BACKGROUND: This register-based observational study compares dabigatran to warfarin for secondary stroke prevention in atrial fibrillation patients among both 'new starters' on dabigatran and 'switchers' to dabigatran from warfarin.

METHODS: We identified in nationwide Danish registries 2,398 patients with atrial fibrillation and a history of stroke/TIA, making a first-time purchase of dabigatran 110mg bid (D110) and 150mg bid (D150). Patients were categorized as either vitamin K antagonist (VKA) naïve or experienced. Warfarin controls were identified using a complete (for VKA-naïve dabigatran patients) or matched sampling approach (for VKA-experienced dabigatran patients). Subjects were followed for an average of 12.6 months for stroke and transient ischemic attacks. Confounder-adjusted Cox regression models were used to compare event rates between treatments.

RESULTS: Among patients with a history of stroke/ transient ischemic attack and prior VKA experience, switching to dabigatran was associated with an increased stroke/ transient ischemic attack rate for both dabigatran doses compared to continuing on warfarin (D110 hazard ratio [HR] 1.99, 95% confidence interval [CI]: 1.42-2.78; D150 HR 2.34, 95% CI: 1.60-3.41). Among prior stroke/ transient ischemic attack patients who were new starters on dabigatran or warfarin, the rate of stroke/ transient ischemic attack for both doses of dabigatran was similar to or lower than warfarin (D110 HR 0.64, 95% CI: 0.50-0.80; D150 HR 0.92, 95% CI: 0.73-1.15).

CONCLUSIONS: In this register-based study, VKA-experienced patients with a history of stroke or transient ischemic attack who switched to dabigatran therapy had an increased rate of stroke compared to patients persisting with warfarin therapy.

Original languageEnglish
JournalAmerican Journal of Medicine
Volume127
Issue number12
Pages (from-to)1172-1178
Number of pages7
ISSN0002-9343
DOIs
Publication statusPublished - 1 Sept 2014

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