國家衛生研究院 NHRI:Item 3990099045/11000
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    题名: Is there a preferred stroke prevention strategy for diabetic patients with non-valvular Atrial Fibrillation? Comparing warfarin, dabigatran and rivaroxaban
    作者: Hsu, CC;Hsu, PF;Sung, SH;Tu, ST;Yu, BH;Huang, CJ;Cheng, HM
    贡献者: Institute of Population Health Sciences
    摘要: BACKGROUND: The prevalence of diabetes is growing, and diabetes is an independent risk factor for both atrial fibrillation (AF) and stroke. However, the relative effectiveness and safety of different oral anticoagulants for diabetic patients with non-valvular AF remain unclear. We aimed to compare thromboembolic events, bleeding and mortality in diabetic AF patients treated with rivaroxaban, dabigatran and warfarin. METHODS AND RESULTS: Diabetic AF patients taking dabigatran (n = 322), rivaroxaban (n = 320) or warfarin (n = 1,899) were identified from the nationwide diabetes pay-for-performance program (n = 814,465) in Taiwan. Outcomes and comorbidities were evaluated by linking with Taiwan National Health Insurance Research Database. Propensity score weighting method was used to balance covariates across study groups. Patients were followed up until the first occurrence of any study outcome or the study end date. Compared with warfarin, dabigatran significantly decreased the risk of all-cause mortality (hazard ratio [HR] = 0.348, 95% confidence interval [CI] = 0.157-0.771) and gastrointestinal bleeding (HR = 0.558, 95% CI = 0.327-0.955). Relative effectiveness and safety outcomes between rivaroxaban and warfarin were comparable. Compared with rivaroxaban, dabigatran significantly decreased the risk of all-cause mortality (HR = 0.310, 95% CI = 0.121-0.798) and was associated with a borderline reduced risk for composite safety end points (HR = 0.670, 95% CI = 0.421-1.067). CONCLUSION: In diabetic AF patients, dabigatran and rivaroxaban showed a superior or non-inferior effectiveness and safety profile compared with warfarin. Dabigatran was associated with a significantly lower risk of mortality than rivaroxaban.
    日期: 2018-01
    關聯: Thrombosis and Haemostasis. 2018 Jan;118(1):72-81.
    Link to: http://dx.doi.org/10.1160/th17-02-0095
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0340-6245&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000424093100008
    Cited Times(Scopus): https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85051642707
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