ArticleJournal of general internal medicine2020
Comparative Safety and Effectiveness of Direct-Acting Oral Anticoagulants Versus Warfarin: a National Cohort Study of Nursing Home Residents.
Article in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 4 of them syntheses that pooled 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.
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.
Who cites it
14 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Comparisons of effectiveness and safety between on-label dosing, off-label underdosing, and off-label overdosing in Asian and non-Asian atrial fibrillation patients treated with rivaroxaban: a systematic review and meta-analysis of observational studies.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Pooled it
- Outcomes and drivers of inappropriate dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: a systematic review and meta-analysis.Heart (British Cardiac Society) · 2023Pooled it
- Standard- vs. low-dose rivaroxaban in patients with atrial fibrillation: a systematic review and meta-analysis.European journal of clinical pharmacology · 2022Pooled it
- Effectiveness and Safety of Oral Anticoagulants in Older Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis.Frontiers in pharmacology · 2020Pooled it
- Oral Anticoagulant Use Among Older Adults in Long-Term Care Facilities: Trends Over Time and Impact of High-Risk Comorbidities.Pharmacoepidemiology and drug safety · 2026Article
- Urine-based point-of-care detection of direct oral anticoagulant activity in acute stroke-accuracy at anti-Xa thresholds relevant for intravenous thrombolysis.Research and practice in thrombosis and haemostasis · 2026Article
- Comparative Effectiveness and Safety of Direct Oral Anticoagulants vs Warfarin among Nursing Home Residents with Atrial Fibrillation: A Retrospective Cohort Study.Journal of the American Medical Directors Association · 2024Article
- To treat or not to treat: a comparative effectiveness analysis of oral anticoagulant outcomes among U.S. nursing home residents with atrial fibrillation.BMC geriatrics · 2024Article
- Inappropriate Underdosing of Direct Oral Anticoagulants in Atrial Fibrillation Patients: Results from the START2-AF Registry.Journal of clinical medicine · 2024Article
- Benefits and Harms of Standard Versus Reduced-Dose Direct Oral Anticoagulant Therapy for Older Adults With Multiple Morbidities and Atrial Fibrillation.Journal of the American Heart Association · 2023Article
- Effectiveness and Safety of Apixaban in over 3.9 Million People with Atrial Fibrillation: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2022Review
- Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes.Journal of clinical medicine · 2022Review
- Efficacy and Safety of Antithrombotic Therapy With Oral Anticoagulants in Real-World Elderly Patients With Acute Coronary Syndrome and Atrial Fibrillation.Frontiers in cardiovascular medicine · 2022Article
- Trends in Anticoagulant Use at Nursing Home Admission and Variation by Frailty and Chronic Kidney Disease Among Older Adults with Atrial Fibrillation.Drugs & aging · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundResearch comparing direct-acting oral anticoagulants (DOACs) to warfarin has excluded nursing home residents, a vulnerable and high-risk population.
objectiveTo compare the safety and effectiveness of DOACs versus warfarin.
designNew-user cohort study (2011-2016). PATIENTS: US nursing home residents aged > 65 years with non-valvular atrial fibrillation enrolled in fee-for-service Medicare for > 6 months. EXPOSURES: Initiators of DOACs (2881 apixaban, 1289 dabigatran, 3735 rivaroxaban) were 1:1 propensity matched to warfarin initiators. MAIN MEASURES: Outcomes included ischemic stroke or transient ischemic attack (i.e., ischemic cerebrovascular event), bleeding (extracranial or intracranial), other vascular events, death, and a composite of all outcomes. Absolute rate differences (RD) and cause-specific hazard ratios (HR) with 95% confidence intervals (CI) were estimated. Subgroup analyses were performed by alignment of DOAC dosing with labeling. KEY
resultsMedian age (84 years), CHA
conclusionsAmong US nursing home residents, the DOACs were each associated with lower mortality versus warfarin. Misaligned DOAC dosing was common in nursing homes and was associated with clinical and mortality outcomes. Overall, DOAC users had lower rates of adverse outcomes including mortality compared with warfarin users.
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