ArticleCirculation. Cardiovascular quality and outcomes2025
Clinical Outcomes of Switching From Warfarin to Apixaban or Rivaroxaban in Patients With Atrial Fibrillation: A Nationwide Multidatabase Study.
Article in Circulation. Cardiovascular quality and outcomes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis 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.
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Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Switching from Vitamin K Antagonists to Direct Oral Anticoagulants in Frail Elderly Patients with Atrial Fibrillation: Systematic Review and Meta-Analysis.Medical sciences (Basel, Switzerland) · 2026Pooled it
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7 authors.
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Abstract
backgroundThe benefits of switching from warfarin to direct oral anticoagulants in atrial fibrillation remain unclear.
methodsThis retrospective study used the Medicare fee-for-service (2013-2020) and Optum Deidentified Clinformatics Data Mart databases (2013-2023). Among patients with atrial fibrillation who received warfarin for at least 180 days, we created 2 cohorts: (1) patients switching to apixaban versus continuing warfarin (the apixaban cohort) and (2) patients switching to rivaroxaban versus continuing warfarin (the rivaroxaban cohort). The index date was the switch date for switchers and a matched date based on warfarin duration for warfarin continuers. After 1:1 propensity score matching, we estimated the rate ratios (RR) for a composite of ischemic stroke, major bleeding, and death in each database and pooled the results using meta-analysis. Subgroup analyses by claims-based frailty and by follow-up time (first 60 days versus beyond 60 days) were performed.
resultsIn the apixaban cohort (n=164 480; mean age, 80.5 years; 55.5% female; median follow-up, 354 days), switching to apixaban was associated with a lower rate of composite outcome (97.1 versus 104.9 per 1000 person-years; rate ratio, 0.92 [95% CI, 0.89-0.95]) compared with continuing warfarin. In the rivaroxaban cohort (n=96 030, mean age 79.7 years, 54.8% female, median follow-up 365 days), switching to rivaroxaban was associated with an increased rate of composite outcome (105.8 versus 99.3 per 1000 person-years; rate ratio, 1.08 [95% CI, 1.04-1.13]). No heterogeneity by frailty levels was observed. However, switching was associated with an initial risk increase within the first 60 days, followed by risk attenuation beyond 60 days, for both apixaban and rivaroxaban.
conclusionsIn patients with atrial fibrillation on warfarin therapy, switching to apixaban may reduce the risk of ischemic stroke, major bleeding, and death, whereas switching to rivaroxaban may increase the risk. For both apixaban and rivaroxaban, switching may temporarily increase risk during the first 60 days.
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