| アブストラクト | Direct oral anticoagulants (DOACs) are widely used for the prevention of ischemic stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). However, the differences in safety and effectiveness among four DOACs, dabigatran, rivaroxaban, apixaban, and edoxaban, in Japanese patients have not been clarified. Therefore, we conducted a retrospective cohort study to directly compare the safety and effectiveness among the four DOACs using the Japan Medical Data Center (JMDC) claims database. We identified 3823 patients with NVAF who started receiving a DOAC between March 2011 and June 2017. The safety outcome was major bleeding (a composite outcome of intracranial, gastrointestinal, respiratory, or renal/urinary tract bleeding) and the effectiveness outcome was the composite of ischemic stroke including transient ischemic attack (TIA) or systemic embolism. We constructed a Cox proportional hazard model to calculate the hazard ratio (HR) for all four DOAC combinations. The risk of major bleeding was significantly lower in the dabigatran group than in the apixaban group (HR, 0.55; 95% confidence interval (CI), 0.31-0.93; p = 0.03). In contrast, there was no significant difference in the risk of major bleeding among the other DOACs. In the composite risk of ischemic stroke including TIA or systemic embolism, there was no significant difference among the four DOACs. This study suggested that in the current use of DOACs in Japanese patients with NVAF, dabigatran had a significantly lower risk of major bleeding than apixaban, but there was no significant difference in effectiveness among the four DOACs. |
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| 投稿日 | 2021/9/3 |
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| 投稿者 | Enomoto, Aya; Mano, Yasunari; Kawano, Yohei; Nishikawa, Tomoki; Aoyama, Takao; Sasaki, Yoshiyuki; Nagata, Masashi; Takahashi, Hiromitsu |
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| ジャーナル名 | Biological & pharmaceutical bulletin |
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| 組織名 | Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University;(TMDU).;Department of Clinical Drug Informatics, Faculty of Pharmaceutical Sciences,;Tokyo University of Science (TUS).;Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Tokyo;University of Science (TUS).;Department of Maxillofacial Surgery, Graduate School of Medical and Dental;Sciences, Tokyo Medical and Dental University (TMDU). |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/34471057/ |
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