1. Direct Comparison of Dabigatran, Rivaroxaban, and Apixaban for Effectiveness and Safety in Non-valvular Atrial Fibrillation

2. Retrospective Analysis Comparing the Safety and Efficacy of NOACs: Objectives
Using a large U.S. administrative database, compare the effectiveness and safety of dabigatran, rivaroxaban, and apixaban in clinical practice
Medical claims data from October 1, 2010 through February 28, 2015 were examined
Primary outcomes were stroke, systemic embolism and major bleeding
Noseworthy PA et al. Chest doi: /j.chest

3. Retrospective Analysis Comparing the Safety and Efficacy of NOACs: Objectives
Three one-to-one propensity-score matched cohorts of patients with non-valvular AF who were users of dabigatran, rivaroxaban, or apixaban was created
Rivaroxaban versus dabigatran [N=31,574]
Apixaban versus dabigatran [N=13,084]
Apixaban versus rivaroxaban [N=13,130])
Noseworthy PA et al. Chest doi: /j.chest

4. Event Rate per 100 Person-Years
Retrospective Analysis Comparing the Safety and Efficacy of NOACs: Results
Effectiveness: Primary Outcome (Stroke or Systemic Embolism)
Event Rate per 100 Person-Years
Hazard Ratio (95% CI) P
Rivaroxaban
vs.
Dabigatran
N=15,787
N=15,787
1.12
1.03
1.00 (0.75, 1.32)
0.99
Favor Rivaroxaban
Favor Dabigatran
Apixaban
vs.
Dabigatran
N=6,542
N=6,542
1.22
1.17
0.82 (0.51, 1.31)
0.41
Favor Apixaban
Favor Dabigatran
Apixaban
vs.
Rivaroxaban
N=6,565
N=6,565
1.21
1.03
1.05 (0.64, 1.72)
0.85
Favor Apixaban
Favor Rivaroxaban
0.0
0.5
2.0
1.0
1.5
Noseworthy PA et al. Chest doi: /j.chest

5. Event Rate per 100 Person-Years
Retrospective Analysis Comparing the Safety and Efficacy of NOACs: Results
Safety: Primary Outcome (Major Bleeding)
Event Rate per 100 Person-Years
Hazard Ratio (95% CI) P
Rivaroxaban
vs.
Dabigatran
N=15,787
N=15,787
3.77
2.58
1.30 (1.10, 1.53)
<0.01
Favor Rivaroxaban
Favor Dabigatran
Apixaban
vs.
Dabigatran
N=6,542
N=6,542
2.06
3.25
0.50 (0.36, 0.70)
<0.001
Favor Apixaban
Favor Dabigatran
Apixaban
vs.
Rivaroxaban
N=6,565
N=6,565
2.01
4.55
0.39 (0.28, 0.54)
<0.001
Favor Apixaban
Favor Rivaroxaban
0.0
0.5
2.0
1.0
1.5
Noseworthy PA et al. Chest doi: /j.chest

6. Event Rate per 100 Person-Years
Retrospective Analysis Comparing the Safety and Efficacy of NOACs: Results
Safety: Secondary Outcome (Intracranial Bleeding)
Event Rate per 100 Person-Years
Hazard Ratio (95% CI) P
0.0
0.5
2.0
3.0
1.0
1.5
2.5
Rivaroxaban
vs.
Dabigatran
N=15,787
N=15,787
0.53
0.26
1.79 (1.12, 2.86)
0.02
Favor Rivaroxaban
Favor Dabigatran
Apixaban
vs.
Dabigatran
N=6,542
N=6,542
0.25
0.34
0.65 (0.25, 1.65)
0.36
Favor Apixaban
Favor Dabigatran
Apixaban
vs.
Rivaroxaban
N=6,565
N=6,565
0.25
0.43
0.56 (0.21, 1.45)
0.23
Favor Apixaban
Favor Rivaroxaban
Noseworthy PA et al. Chest doi: /j.chest

7. Retrospective Analysis Comparing the Safety and Efficacy of NOACs: Results
No differences were found between the three NOACs in the risk of stroke or systemic embolism for rivaroxaban vs. dabigatran, apixaban vs. dabigatran and apixaban vs. rivaroxaban
Rivaroxaban was associated with increased risk of major bleeding and intracranial bleeding compared to dabigatran
Apixaban was associated with lower major bleeding risk vs. dabigatran and rivaroxaban
Noseworthy PA et al. Chest doi: /j.chest

8. Retrospective Analysis Comparing the Safety and Efficacy of NOACs: Summary
Dabigatran, rivaroxaban, and apixaban appear to have equivalent effectiveness
Apixaban appears to be associated with lower risk of major bleeding whereas rivaroxaban is associated with higher risk of major bleeding
Noseworthy PA et al. Chest doi: /j.chest