Dabigatran and The Risk of Staphylococcus Aureus Bacteremia: A Nationwide Cohort Study

Jawad H Butt; Emil L Fosbøl; Peter Verhamme; Thomas A Gerds; Kasper Iversen; Henning Bundgaard; Niels Eske Bruun; Anders R Larsen; Andreas Petersen; Paal S Andersen; Robert L Skov; Gunnar H Gislason; Christian Torp-Pedersen; Lars Køber; Jonas B Olesen

doi:10.1093/cid/ciaa661

Dabigatran and The Risk of Staphylococcus Aureus Bacteremia: A Nationwide Cohort Study

Jawad H Butt^*, Emil L Fosbøl, Peter Verhamme, Thomas A Gerds, Kasper Iversen, Henning Bundgaard, Niels Eske Bruun, Anders R Larsen, Andreas Petersen, Paal S Andersen, Robert L Skov, Gunnar H Gislason, Christian Torp-Pedersen, Lars Køber, Jonas B Olesen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

BACKGROUND: Treatment with dabigatran, an oral direct thrombin inhibitor, reduces the virulence of Staphylococcus aureus in in vitro and in vivo models. However, it remains to be determined whether dabigatran reduces the risk of S. aureus infections in humans. We investigated the incidence rate of Staphylococcus aureus bacteremia (SAB) in patients with atrial fibrillation treated with the direct thrombin inhibitor, dabigatran, compared with patients treated with the factor Xa-inhibitors, rivaroxaban, apixaban, and edoxaban.

METHODS: In this observational cohort study, 112,537 patients with atrial fibrillation who initiated treatment with direct oral anticoagulants (August 2011-December 2017) were identified from Danish nationwide registries. The incidence rates of SAB in patients treated with dabigatran versus patients treated with the factor Xa-inhibitors were examined by multivariable Cox regression accounting for time-dynamic changes of exposure status during follow-up.

RESULTS: A total of 112,537 patients were included. During a median follow-up of 2.0 years, 186 patients in the dabigatran group and 356 patients in the factor Xa-inhibitor group were admitted with SAB. The crude incidence rate of SAB was lower in the dabigatran group compared with the factor Xa-inhibitor group (22.8 [95%CI,19.7-26.3] and 33.8 [95%CI,30.5-37.6] events per 10.000 person-years, respectively). In adjusted analyses, dabigatran was associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio 0.76 [95%CI,0.63-0.93]).

CONCLUSIONS: Treatment with dabigatran was associated with a significantly lower incidence rate of SAB compared with treatment with factor Xa-inhibitors.

Original language	English
Article number	ciaa661
Journal	Clinical Infectious Diseases
Volume	73
Issue number	3
Pages (from-to)	480–486
Number of pages	7
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/ciaa661
Publication status	Published - 1 Aug 2021

Keywords

S. aureus
dabigatran
epidemiology

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10.1093/cid/ciaa661

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Butt, J. H., Fosbøl, E. L., Verhamme, P., Gerds, T. A., Iversen, K., Bundgaard, H., Bruun, N. E., Larsen, A. R., Petersen, A., Andersen, P. S., Skov, R. L., Gislason, G. H., Torp-Pedersen, C., Køber, L., & Olesen, J. B. (2021). Dabigatran and The Risk of Staphylococcus Aureus Bacteremia: A Nationwide Cohort Study. Clinical Infectious Diseases, 73(3), 480–486. Article ciaa661. Advance online publication. https://doi.org/10.1093/cid/ciaa661

@article{4ede636737044ad2843e36d799a44022,

title = "Dabigatran and The Risk of Staphylococcus Aureus Bacteremia: A Nationwide Cohort Study",

abstract = "BACKGROUND: Treatment with dabigatran, an oral direct thrombin inhibitor, reduces the virulence of Staphylococcus aureus in in vitro and in vivo models. However, it remains to be determined whether dabigatran reduces the risk of S. aureus infections in humans. We investigated the incidence rate of Staphylococcus aureus bacteremia (SAB) in patients with atrial fibrillation treated with the direct thrombin inhibitor, dabigatran, compared with patients treated with the factor Xa-inhibitors, rivaroxaban, apixaban, and edoxaban.METHODS: In this observational cohort study, 112,537 patients with atrial fibrillation who initiated treatment with direct oral anticoagulants (August 2011-December 2017) were identified from Danish nationwide registries. The incidence rates of SAB in patients treated with dabigatran versus patients treated with the factor Xa-inhibitors were examined by multivariable Cox regression accounting for time-dynamic changes of exposure status during follow-up.RESULTS: A total of 112,537 patients were included. During a median follow-up of 2.0 years, 186 patients in the dabigatran group and 356 patients in the factor Xa-inhibitor group were admitted with SAB. The crude incidence rate of SAB was lower in the dabigatran group compared with the factor Xa-inhibitor group (22.8 [95%CI,19.7-26.3] and 33.8 [95%CI,30.5-37.6] events per 10.000 person-years, respectively). In adjusted analyses, dabigatran was associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio 0.76 [95%CI,0.63-0.93]).CONCLUSIONS: Treatment with dabigatran was associated with a significantly lower incidence rate of SAB compared with treatment with factor Xa-inhibitors.",

keywords = "S. aureus, dabigatran, epidemiology",

author = "Butt, {Jawad H} and Fosb{\o}l, {Emil L} and Peter Verhamme and Gerds, {Thomas A} and Kasper Iversen and Henning Bundgaard and Bruun, {Niels Eske} and Larsen, {Anders R} and Andreas Petersen and Andersen, {Paal S} and Skov, {Robert L} and Gislason, {Gunnar H} and Christian Torp-Pedersen and Lars K{\o}ber and Olesen, {Jonas B}",

year = "2021",

month = aug,

day = "1",

doi = "10.1093/cid/ciaa661",

language = "English",

volume = "73",

pages = "480–486",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "3",

}

Butt, JH, Fosbøl, EL, Verhamme, P, Gerds, TA, Iversen, K, Bundgaard, H, Bruun, NE, Larsen, AR, Petersen, A, Andersen, PS, Skov, RL, Gislason, GH, Torp-Pedersen, C, Køber, L & Olesen, JB 2021, 'Dabigatran and The Risk of Staphylococcus Aureus Bacteremia: A Nationwide Cohort Study', Clinical Infectious Diseases, vol. 73, no. 3, ciaa661, pp. 480–486. https://doi.org/10.1093/cid/ciaa661

TY - JOUR

T1 - Dabigatran and The Risk of Staphylococcus Aureus Bacteremia

T2 - A Nationwide Cohort Study

AU - Butt, Jawad H

AU - Fosbøl, Emil L

AU - Verhamme, Peter

AU - Gerds, Thomas A

AU - Iversen, Kasper

AU - Bundgaard, Henning

AU - Bruun, Niels Eske

AU - Larsen, Anders R

AU - Petersen, Andreas

AU - Andersen, Paal S

AU - Skov, Robert L

AU - Gislason, Gunnar H

AU - Torp-Pedersen, Christian

AU - Køber, Lars

AU - Olesen, Jonas B

PY - 2021/8/1

Y1 - 2021/8/1

N2 - BACKGROUND: Treatment with dabigatran, an oral direct thrombin inhibitor, reduces the virulence of Staphylococcus aureus in in vitro and in vivo models. However, it remains to be determined whether dabigatran reduces the risk of S. aureus infections in humans. We investigated the incidence rate of Staphylococcus aureus bacteremia (SAB) in patients with atrial fibrillation treated with the direct thrombin inhibitor, dabigatran, compared with patients treated with the factor Xa-inhibitors, rivaroxaban, apixaban, and edoxaban.METHODS: In this observational cohort study, 112,537 patients with atrial fibrillation who initiated treatment with direct oral anticoagulants (August 2011-December 2017) were identified from Danish nationwide registries. The incidence rates of SAB in patients treated with dabigatran versus patients treated with the factor Xa-inhibitors were examined by multivariable Cox regression accounting for time-dynamic changes of exposure status during follow-up.RESULTS: A total of 112,537 patients were included. During a median follow-up of 2.0 years, 186 patients in the dabigatran group and 356 patients in the factor Xa-inhibitor group were admitted with SAB. The crude incidence rate of SAB was lower in the dabigatran group compared with the factor Xa-inhibitor group (22.8 [95%CI,19.7-26.3] and 33.8 [95%CI,30.5-37.6] events per 10.000 person-years, respectively). In adjusted analyses, dabigatran was associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio 0.76 [95%CI,0.63-0.93]).CONCLUSIONS: Treatment with dabigatran was associated with a significantly lower incidence rate of SAB compared with treatment with factor Xa-inhibitors.

AB - BACKGROUND: Treatment with dabigatran, an oral direct thrombin inhibitor, reduces the virulence of Staphylococcus aureus in in vitro and in vivo models. However, it remains to be determined whether dabigatran reduces the risk of S. aureus infections in humans. We investigated the incidence rate of Staphylococcus aureus bacteremia (SAB) in patients with atrial fibrillation treated with the direct thrombin inhibitor, dabigatran, compared with patients treated with the factor Xa-inhibitors, rivaroxaban, apixaban, and edoxaban.METHODS: In this observational cohort study, 112,537 patients with atrial fibrillation who initiated treatment with direct oral anticoagulants (August 2011-December 2017) were identified from Danish nationwide registries. The incidence rates of SAB in patients treated with dabigatran versus patients treated with the factor Xa-inhibitors were examined by multivariable Cox regression accounting for time-dynamic changes of exposure status during follow-up.RESULTS: A total of 112,537 patients were included. During a median follow-up of 2.0 years, 186 patients in the dabigatran group and 356 patients in the factor Xa-inhibitor group were admitted with SAB. The crude incidence rate of SAB was lower in the dabigatran group compared with the factor Xa-inhibitor group (22.8 [95%CI,19.7-26.3] and 33.8 [95%CI,30.5-37.6] events per 10.000 person-years, respectively). In adjusted analyses, dabigatran was associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio 0.76 [95%CI,0.63-0.93]).CONCLUSIONS: Treatment with dabigatran was associated with a significantly lower incidence rate of SAB compared with treatment with factor Xa-inhibitors.

KW - S. aureus

KW - dabigatran

KW - epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85100843361&partnerID=8YFLogxK

U2 - 10.1093/cid/ciaa661

DO - 10.1093/cid/ciaa661

M3 - Journal article

C2 - 32478836

SN - 1058-4838

VL - 73

SP - 480

EP - 486

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 3

M1 - ciaa661

ER -

Dabigatran and The Risk of Staphylococcus Aureus Bacteremia: A Nationwide Cohort Study

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