Photo Credit: Alena Butusava
The following is a summary of “Comparative effectiveness of factor Xa non-vitamin K antagonist oral anticoagulants versus phenprocoumon in patients with non-valvular atrial fibrillation,” published in the June 2024 issue of Cardiology by Kreutz et al.
Non-vitamin K antagonist oral anticoagulants (NOACs) have mostly replaced vitamin K antagonists (VKAs) for treating non-valvular atrial fibrillation (NVAF). However, there is limited real-world data on NOACs versus phenprocoumon, a VKA common in Germany.
Researchers conducted a prospective study comparing the effectiveness of factors Xa NOACs and phenprocoumon in everyday clinical practice for NVAF.
They enrolled patients with NVAF, starting with factor Xa NOACs or phenprocoumon from the Institute for Applied Healthcare Research Berlin. Patients were tracked from the first prescription until the end of exposure or available data. Using Cox models, primary outcomes were analyzed along with ischemic stroke and systemic embolism for effectiveness and intracranial hemorrhage (ICH) for safety, focusing on diabetes and renal impairment subgroups.
The results showed that 64,920 patients were studied. Of these, 36.3% of patients initiated phenprocoumon, 34.4% initiated rivaroxaban, 25.0% apixaban, and 4.4% edoxaban. Phenprocoumon had a similar risk of ischemic stroke/systemic embolism as rivaroxaban or apixaban. Rivaroxaban (HR 0.57, 95% CI: 0.43-0.75) and apixaban (HR 0.43, 95% CI: 0.31-0.6) had a lower risk of ICH. Both were also linked to lower kidney failure risk in patients with diabetes or renal impairment compared to phenprocoumon.
Investigators concluded that rivaroxaban and apixaban are as effective as phenprocoumon and have lower rates of ICH in this study.
Source: sciencedirect.com/science/article/abs/pii/S0167527324003401
