Comparative effectiveness of dabigatran, rivaroxaban, apixaban, and warfarin in the management of patients with nonvalvular atrial fibrillation

Clin Pharmacol Ther. 2013 Aug;94(2):269-76. doi: 10.1038/clpt.2013.83. Epub 2013 Apr 25.

Abstract

Alternative anticoagulants to warfarin (dabigatran, rivaroxaban, and apixaban) are becoming available for the prevention of thromboembolic stroke in atrial fibrillation (AF), but there is a lack of information on their comparative effectiveness. Using a discrete event simulation method adopting a lifetime horizon of analysis, we made an indirect comparison of the RE-LY, ROCKET-AF, and ARISTOTLE trial results for AF patients in the US population. Over a lifetime, apixaban, dabigatran, and rivaroxaban accrued 0.130 (95% central range (CR) -0.030 to 0.264), 0.106 (95% CR -0.048 to 0.248), and 0.095 (95% CR -0.052 to 0.242) more quality-adjusted life-years (QALYs), respectively, than warfarin, with apixaban having a 55% probability of accruing the highest total QALYs. In the absence of a definitive trial, and acknowledging the limitations of an indirect comparison, the available evidence suggests apixaban to be the most effective anticoagulant.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Antithrombins / administration & dosage
  • Antithrombins / adverse effects
  • Antithrombins / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Benzimidazoles / therapeutic use
  • Cardiovascular Diseases / epidemiology
  • Comorbidity
  • Computer Simulation*
  • Dabigatran
  • Female
  • Hemorrhage / chemically induced
  • Humans
  • Male
  • Morpholines / therapeutic use
  • Pyrazoles / therapeutic use
  • Pyridones / therapeutic use
  • Quality-Adjusted Life Years
  • Randomized Controlled Trials as Topic
  • Rivaroxaban
  • Thiophenes / therapeutic use
  • Time Factors
  • Warfarin / therapeutic use
  • beta-Alanine / analogs & derivatives
  • beta-Alanine / therapeutic use

Substances

  • Antithrombins
  • Benzimidazoles
  • Morpholines
  • Pyrazoles
  • Pyridones
  • Thiophenes
  • beta-Alanine
  • apixaban
  • Warfarin
  • Rivaroxaban
  • Dabigatran