Show simple item record

dc.contributor.authorAlcusky, Matthew J
dc.contributor.authorHume, Anne L.
dc.contributor.authorFisher, Marc
dc.contributor.authorTjia, Jennifer
dc.contributor.authorGoldberg, Robert J.
dc.contributor.authorMcManus, David D.
dc.contributor.authorLapane, Kate L.
dc.date2022-08-11T08:11:02.000
dc.date.accessioned2022-08-23T17:29:29Z
dc.date.available2022-08-23T17:29:29Z
dc.date.issued2018-12-01
dc.date.submitted2019-01-15
dc.identifier.citation<p>Drugs Aging. 2018 Dec;35(12):1089-1098. doi: 10.1007/s40266-018-0610-y. <a href="https://doi.org/10.1007/s40266-018-0610-y">Link to article on publisher's site</a></p>
dc.identifier.issn1170-229X (Linking)
dc.identifier.doi10.1007/s40266-018-0610-y
dc.identifier.pmid30421391
dc.identifier.urihttp://hdl.handle.net/20.500.14038/50330
dc.description.abstractBACKGROUND: 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.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=30421391&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1007/s40266-018-0610-y
dc.subjectUMCCTS funding
dc.subjectCardiology
dc.subjectCardiovascular Diseases
dc.subjectGeriatrics
dc.subjectHealth Services Administration
dc.subjectNervous System Diseases
dc.subjectNeurology
dc.subjectPharmaceutical Preparations
dc.subjectTherapeutics
dc.subjectTranslational Medical Research
dc.titleDabigatran Versus Rivaroxaban for Secondary Stroke Prevention in Patients with Atrial Fibrillation Rehabilitated in Skilled Nursing Facilities
dc.typeJournal Article
dc.source.journaltitleDrugs and aging
dc.source.volume35
dc.source.issue12
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/umccts_pubs/157
dc.identifier.contextkey13626728
html.description.abstract<p>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.</p> <p>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).</p> <p>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).</p> <p>CONCLUSIONS: In older adults treated with direct-acting oral anticoagulants after ischemic stroke, outcome rates varied considerably by drug and dosage.</p>
dc.identifier.submissionpathumccts_pubs/157
dc.contributor.departmentDivision of Cardiovascular Medicine, Department of Medicine
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages1089-1098


This item appears in the following Collection(s)

Show simple item record