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    Dabigatran Versus Rivaroxaban for Secondary Stroke Prevention in Patients with Atrial Fibrillation Rehabilitated in Skilled Nursing Facilities

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    Authors
    Alcusky, Matthew J
    Hume, Anne L.
    Fisher, Marc
    Tjia, Jennifer
    Goldberg, Robert J.
    McManus, David D.
    Lapane, Kate L.
    UMass Chan Affiliations
    Division of Cardiovascular Medicine, Department of Medicine
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2018-12-01
    Keywords
    UMCCTS funding
    Cardiology
    Cardiovascular Diseases
    Geriatrics
    Health Services Administration
    Nervous System Diseases
    Neurology
    Pharmaceutical Preparations
    Therapeutics
    Translational Medical Research
    
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    Link to Full Text
    https://doi.org/10.1007/s40266-018-0610-y
    Abstract
    BACKGROUND: Thromboembolic and bleeding risk are elevated in older patients with atrial fibrillation and prior stroke. We compared dabigatran with rivaroxaban for secondary prevention in a national population after skilled nursing facility (SNF) discharge. METHODS: Medicare fee-for-service beneficiaries aged > /= 65 years with atrial fibrillation hospitalized for ischemic stroke (November 2011-October 2013) and subsequently admitted to an SNF were studied. Dabigatran (n = 332) and rivaroxaban users (n = 378) were compared in a retrospective, active comparator, new-user cohort. The index medication claim occurred within 120 days after hospital discharge and exposure continued until a 14-day treatment gap ('as treated'). The primary net clinical benefit outcome was the time to recurrent stroke, transient ischemic attack, intracranial hemorrhage, extracranial bleed, myocardial infarction, venous thromboembolism, or death. All-cause mortality was evaluated separately as a secondary outcome. Multivariable adjusted Cox models stratified by dosage estimated hazard ratios (aHR). RESULTS: Among those receiving low dosages, the crude composite event rate was 40.4/100 person-years among dabigatran users and 33.7/100 person-years among rivaroxaban users. The composite outcome [aHR 1.48; 95% confidence interval (CI) 0.87-2.51] and all-cause mortality (aHR 1.67; 95% CI 0.84-3.31) rates were higher among low-dose dabigatran users. For those receiving standard doses, the crude composite event rates were 19.5/100 person-years for dabigatran users and 37.1/100 person-years for rivaroxaban users. Although no difference in mortality was observed, the composite outcome rate was lower among standard-dose dabigatran users (aHR 0.65; 95% CI 0.36-1.15). CONCLUSIONS: In older adults treated with direct-acting oral anticoagulants after ischemic stroke, outcome rates varied considerably by drug and dosage.
    Source

    Drugs Aging. 2018 Dec;35(12):1089-1098. doi: 10.1007/s40266-018-0610-y. Link to article on publisher's site

    DOI
    10.1007/s40266-018-0610-y
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/50330
    PubMed ID
    30421391
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    ae974a485f413a2113503eed53cd6c53
    10.1007/s40266-018-0610-y
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