ArticleEuropean journal of clinical pharmacology2018
Comparative risks of bleeding, ischemic stroke and mortality with direct oral anticoagulants versus phenprocoumon in patients with atrial fibrillation.
Article in European journal of clinical pharmacology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 4 of them syntheses that pooled it.
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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.
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.
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Who cites it
16 citing papers in PubMed, 4 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Direct Oral Anticoagulants Versus Phenprocoumon: Mortality, Thromboembolism and Major Hemorrhage. A Systematic Review and Meta-Analysis of Routine Data Studies.Deutsches Arzteblatt international · 2026Pooled it
- Clinical Practice Guideline: Preventive Measures and Treatment Options for Atrial Fibrillation.Deutsches Arzteblatt international · 2025Guideline
- Real-world evidence comparing oral anticoagulants for NVAF in Europe: a systematic review and network meta-analysis.Future cardiology · 2025Pooled it
- Effectiveness and Safety of Dabigatran Compared to Vitamin K Antagonists in Non-Asian Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.Clinical drug investigation · 2021Pooled it
- Comparative Analysis of Drugs Frequently Suspected of Causing Adverse Drug Reactions Reported via the Spontaneous Reporting System Versus in a Prospective Multicentre Cohort Study in Hospital Emergency Departments.Journal of clinical medicine · 2025Article
- Pharmacodynamic Drug-Drug Interactions and Bleeding Outcomes in Patients with Atrial Fibrillation Using Non-Vitamin K Antagonist Oral Anticoagulants: a Nationwide Cohort Study.Cardiovascular drugs and therapy · 2025Article
- Observational
- Long-term comparative effectiveness and safety of dabigatran, rivaroxaban, apixaban and edoxaban in patients with atrial fibrillation: A nationwide cohort study.Frontiers in pharmacology · 2023Article
- Review
- [Prescribing behavior of Bavarian general practitioners at the inpatient-outpatient interface within the context of the Bavarian active substance agreement-qualitative results of the WirtMed Study].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2022Article
- Comparing risk of major bleeding between users of different oral anticoagulants in patients with nonvalvular atrial fibrillation.British journal of clinical pharmacology · 2021Article
- Observational
- Drug interactions with oral anticoagulants in German nursing home residents: comparison between vitamin K antagonists and non-vitamin K antagonist oral anticoagulants based on two nested case-control studies.Clinical research in cardiology : official journal of the German Cardiac Society · 2020Article
- Comparative effectiveness of rivaroxaban versus a vitamin K antagonist in patients with renal impairment treated for non-valvular atrial fibrillation in Germany - A retrospective cohort study.International journal of cardiology. Heart & vasculature · 2019Article
- Cause of Discrepancy.Deutsches Arzteblatt international · 2019Article
- Cost-benefit analysis of VKA versus NOAC treatment in German patients with atrial fibrillation utilizing patient self-testing.Journal of health economics and outcomes research · 2019Article
Corrections and comments
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Authors and funding
13 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe pivotal trials for stroke prevention in non-valvular atrial fibrillation (NVAF) compared rivaroxaban, dabigatran, and apixaban with warfarin, as did most claims-based studies. Comparisons with phenprocoumon, the most frequently used vitamin K antagonist (VKA) in Germany, are scarce.
methodsRisk of bleeding, ischemic stroke, and all-cause mortality in patients with NVAF were analyzed using data for 2010 to 2014 from a large German claims database. New users of oral anticoagulants from January 2012 to December 2013 were included and observed over 1 year. Baseline characteristics were adjusted using propensity score matching and logistic regression. Several sensitivity analyses were carried out.
resultsFifty-nine thousand four hundred forty-nine rivaroxaban, 23,654 dabigatran, 4894 apixaban, and 87,997 matched phenprocoumon users were included. Adjusted hazard ratios (95% confidence intervals) compared with phenprocoumon were as follows: hospitalized bleedings: rivaroxaban 1.04 (0.97; 1.11), dabigatran 0.87 (0.77; 0.98), and apixaban 0.65 (0.50; 0.86); ischemic stroke: rivaroxaban 1.05 (0.94; 1.17), dabigatran 1.14 (0.96; 1.35), and apixaban 1.84 (1.20; 2.84); all-cause mortality: rivaroxaban 1.17 (1.11; 1.22), dabigatran 1.04 (0.95; 1.13), and apixaban 1.14 (0.97; 1.34).
conclusionsWith rivaroxaban, no significant differences were observed compared to phenprocoumon with regard to hospitalized bleedings or ischemic strokes. Dabigatran was associated with fewer bleedings and a similar risk of ischemic strokes compared to phenprocoumon. Apixaban was also associated with fewer bleedings but was unexpectedly associated with more ischemic strokes, possibly reflecting selective prescribing. The association of rivaroxaban with higher all-cause mortality unrelated to bleedings or strokes has been described previously but remains to be explained.
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