Evidence map›Paper›PMID 29654196›Full record

Observational studyJournal of the American Heart Association2018

Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Frail Patients With Nonvalvular Atrial Fibrillation.

Brandon K Martinez, Nitesh A Sood, Thomas J Bunz, Craig I Coleman

Open access · goldAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of the American Heart Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 6 pooled it
39.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 6 syntheses or guidelines pooled it, 106 citations in OpenAlex.

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  18. Progression of Frailty and Cardiovascular Outcomes Among Medicare Beneficiaries.medRxiv : the preprint server for health sciences · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Brandon K MartinezDepartment of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT.
Nitesh A SoodDepartment of Cardiac Electrophysiology, Southcoast Health System, Fall River, MA.
Thomas J BunzNew England Health Analytics, LLC, Granby, CT.
Craig I ColemanDepartment of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT craig.coleman@hhchealth.org.
Hartford Hospital · USSouthCoast Health · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFrailty predicts poorer outcomes and decreased anticoagulation use in patients with nonvalvular atrial fibrillation. We sought to assess the effectiveness and safety of apixaban, dabigatran and rivaroxaban versus warfarin in frail nonvalvular atrial fibrillation patients. METHODS AND

resultsUsing US MarketScan claims data from November 2011 to December 2016, we identified frail oral anticoagulant-naïve nonvalvular atrial fibrillation patients with ≥12 months of continuous insurance coverage before oral anticoagulant initiation. Frailty status was determined using the Johns Hopkins Claims-based Frailty Indicator score (≥0.20 indicating frailty). Users of apixaban, dabigatran, or rivaroxaban were separately 1:1 matched to warfarin users via propensity-scores, with residual absolute standardized differences <0.1 being achieved for all covariates after matching. Patients were followed for up to 2 years or until an event, insurance disenrollment or end of follow-up. Rates of stroke or systemic embolism and major bleeding were compared using Cox regression and reported as hazard ratios (HRs) and 95% confidence intervals (CIs). In total, 2700, 2784, and 5270 patients were included in the apixaban, dabigatran, and rivaroxaban 1:1 matched analyses to warfarin. At 2 years, neither apixaban nor dabigatran were associated with differences in the hazard of stroke or systemic embolism (HR=0.78; 95% CI=0.46-1.35 and HR=0.94; 0.60-1.45) or major bleeding (HR=0.72; 95% CI=0.49-1.06 and HR=0.87; 95% CI=0.63-1.19) versus warfarin. Rivaroxaban was associated with reduced stroke or systemic embolism at 2 years (HR=0.68; 95% CI=0.49-0.95) without significantly altering major bleeding risk (HR=1.07; 95% CI=0.81-1.32).

conclusionsOur study found rivaroxaban but not apixaban or dabigatran to be associated with reduced SSE versus warfarin in frail nonvalvular atrial fibrillation patients. No direct-acting oral anticoagulants demonstrated a significant difference in major bleeding versus warfarin.

Indexed as

Frail ElderlyAdministration, OralAgedAged, 80 and overAnticoagulantsAtrial FibrillationDabigatranDose-Response Relationship, DrugDrug Therapy, CombinationFactor Xa InhibitorsFemaleFollow-Up StudiesHumansIncidenceMalePyrazolesAnticoagulantsapixabanDabigatranFactor Xa InhibitorsPyrazolesPyridonesRivaroxabanWarfarinanticoagulantsatrial fibrillationdirect‐acting oral anticoagulantsfrailtywarfarin

Identifiers

PMID29654196
PMCPMC6015429
OpenAlexW2796691103

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.