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Safety and Effectiveness of Oral Anticoagulants in Patients With Non-valvular Atrial Fibrillation

SAFETY AND EFFECTIVENESS EVALUATION OF PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION TREATED WITH OACS: COMPARISON BETWEEN NOACS AND WARFARIN (CER3)

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT03570047
Acronym
CER3
Enrollment
73989
Registered
2018-06-26
Start date
2018-05-08
Completion date
2018-10-31
Last updated
2019-11-04

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Non-valvular Atrial Fibrillation

Keywords

Non-valvular atrial fibrillation, NVAF

Brief summary

An anticoagulation therapy is a critical treatment to prevent thromboembolism in non-valvular AF (NVAF) patients. Warfarin, a vitamin K antagonist, is the first oral anticoagulant approved for the treatment for prevention of thromboembolism and it had long been the only oral anticoagulant until the first non-vitamin K antagonist oral anticoagulants (NOACs). However, its safety and effectiveness remains unknown in real-world clinical practice in Japan

Detailed description

An anticoagulation therapy is a critical treatment to prevent thromboembolism in non-valvular AF (NVAF) patients. Warfarin, a vitamin K antagonist, is the first oral anticoagulant approved for the treatment for prevention of thromboembolism and it had long been the only oral anticoagulant until the first non-vitamin K antagonist oral anticoagulants (NOACs). However, its safety and effectiveness remains unknown in real-world clinical practice in Japan. This study will evaluate the risk of stroke/SE as well as the risk of bleeding in the real world settings in Japan in patients with NVAF who initiated any of OACs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin)

Interventions

None listed

Sponsors

Pfizer
Lead SponsorINDUSTRY

Study design

Observational model
COHORT
Time perspective
RETROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Patients must meet all of the following criteria to be eligible for the study: 1. Diagnosed with AF anytime in the baseline period or on the index date, also have definitive diagnosis of AF anytime in the baseline period, on the index date, or post-index period. 2. Prescribed one of the index OACs (apixaban, dabigatran, edoxaban, rivaroxaban or warfarin) on or after the day of AF diagnosis. The first observed prescription will be used to identify the patient's index date and treatment cohort 3. No use of the any OACs during the baseline period (the 180 days before the index date) 4. Age of 18 years or older on the index date.

Exclusion criteria

Patients meeting any of the following criteria will not be included in the study: 1\. Having a diagnosis of valvular atrial fibrillation, post-operative atrial fibrillation, rheumatic atrial fibrillation or mechanical-valvular atrial fibrillation during the baseline and post-index period 2. Having a cardiac surgery procedure record during the baseline period 3. Having a joint replacement procedure record during the baseline period 4. Having a procedure of prosthetic heart valve during the baseline period 5. Having a diagnosis of venous thromboembolism during the baseline period 6. Female patients with pregnancy during the follow-up period 7. Patients prescribed off-label doses of OACs (per Japanese package insert of each OAC) or patients treated with OAC but in off-label or contraindicated manners. \-

Design outcomes

Primary

MeasureTime frameDescription
Event Rate Per 100 Participant-Years For First Occurrence of Stroke and Systemic Embolism Events After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of stroke and systemic embolism events after index date was reported. Stroke events included the composite of any ischemic and any hemorrhagic stroke events (non-traumatic extradural hemorrhage). Systemic embolism events were defined as any of the following: abdominal aortic embolism, aortic embolism, acute arterial occlusive disease of arteries of upper extremities, femoral arterial occlusion and acute arterial occlusive disease of arteries of lower extremities, iliac artery embolism, hepatic artery embolism, thromboembolism, embolic infarction, aortic embolism, subclavian artery stenosis. Index date was defined as date of first prescription of any OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.
Event Rate Per 100 Participant-Years For First Occurrence of Major Bleeding Events After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of major bleeding event after index date was reported. Major bleeding after index date was identified using hospital claims which had a bleeding diagnosis code as the first listed in International Statistical Classification of Diseases and Related Health Problems (ICD)-10 diagnosis code. An event occurrence of major bleeding was defined as that appears as 21: Disease name behind hospitalization in database. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.
Event Rate Per 100 Participant-Years For First Occurrence of Any Bleeding Event After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of any bleeding event after index date was reported. Any bleeding was defined using ICD-10 diagnosis codes and participants were considered to have any bleeding if pre-defined bleeding-associated ICD-10 diagnosis codes appeared in the records. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Secondary

MeasureTime frameDescription
Event Rate Per 100 Participant-Years For First Occurrence of Major Gastrointestinal Bleeding Events After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of major gastrointestinal bleeding events after index date was reported. Major gastrointestinal bleeding after index date was identified using hospital claims which had a gastrointestinal bleeding diagnosis code as the first listed ICD-10 diagnosis code. An event occurrence of major bleeding was defined as that appears as 21: Disease name behind hospitalization in database. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.
Event Rate Per 100 Participant-Years For First Occurrence of Any Gastrointestinal Bleeding Event After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of any gastrointestinal bleeding event after index date was reported. Any gastrointestinal bleeding was defined by ICD-10 diagnosis codes. If participants had ICD-10 diagnosis codes which suggest bleeding from the gastrointestinal tract, they were considered to have any gastrointestinal bleeding. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.
Event Rate Per 100 Participant-Years For First Occurrence of Ischemic Stroke After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of ischemic stroke after index date was reported. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.
Event Rate Per 100 Participant-Years For First Occurrence of Any Intracranial Hemorrhage Event After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of any intracranial hemorrhage event after index date was reported. Any intracranial hemorrhage was defined by ICD-10 diagnosis codes and participants were considered to have any intracranial hemorrhagic event if pre-defined any intracranial hemorrhagic-associated ICD-10 diagnosis codes appeared in the records. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.
Event Rate Per 100 Participant-Years For First Occurrence of Major Intracranial Hemorrhage Events After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of major intracranial hemorrhage events after index date was reported. Major intracranial hemorrhage was defined by ICD-10 diagnosis codes and participants were considered to have major intracranial hemorrhage if pre-defined major intracranial hemorrhagic-associated ICD-10 diagnosis codes appeared in the records. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.
Event Rate Per 100 Participant-Years For First Occurrence of Hemorrhagic Stroke After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of hemorrhagic stroke after index date was reported. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.
Event Rate Per 100 Participant-Years For First Occurrence of Systemic Embolism Events After Index DateDuring the observation period of approximately 7 yearsEvent rate per 100 participant-years for first occurrence of systemic embolism events after index date was reported. Systemic embolism events included any of the following: abdominal aortic embolism, aortic embolism, acute arterial occlusive disease of arteries of upper extremities, femoral arterial occlusion and acute arterial occlusive disease of arteries of lower extremities, iliac artery embolism, hepatic artery embolism, thromboembolism, embolic infarction, aortic embolism, subclavian artery stenosis. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Countries

Japan

Participant flow

Recruitment details

It is a retrospective population-based register study. Data of each participant diagnosed with non-valvular atrial fibrillation (NAVF) was retrieved from Medical Data Vision (MDV) database for the duration of approximately 7 years (March 2011 to December 2017).

Pre-assignment details

In this study, inverse probability of treatment weighted (IPTW) method was used in analysis of outcome measures to balance participant's characteristics among reporting groups.

Participants by arm

ArmCount
Warfarin
OACs treatment-naive participants diagnosed with NVAF, who initiated warfarin on the index date, were included in this study cohort and their data (for the duration of approximately 7 years observation period, i.e. 2011-2017) available in MDV database was retrospectively observed. Index date was defined as the date of the first prescription of any OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during observation period.
15,902
Apixaban
OACs treatment-naive participants diagnosed with NVAF, who initiated apixaban on the index date, were included in this study cohort and their data (for the duration of approximately 7 years observation period, i.e. 2011-2017) available in MDV database was retrospectively observed. Index date was defined as the date of the first prescription of any OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during observation period.
22,336
Dabigatran
OACs treatment-naive participants diagnosed with NVAF, who initiated dabigatran on the index date, were included in this study cohort and their data (for the duration of approximately 7 years observation period, i.e. 2011-2017) available in MDV database was retrospectively observed. Index date was defined as the date of the first prescription of any OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during observation period.
6,925
Rivaroxaban
OACs treatment-naive participants diagnosed with NVAF, who initiated rivaroxaban on the index date, were included in this study cohort and their data (for the duration of approximately 7 years observation period, i.e. 2011-2017) available in MDV database was retrospectively observed. Index date was defined as the date of the first prescription of any OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during observation period.
16,564
Edoxaban
OACs treatment-naive participants diagnosed with NVAF, who initiated edoxaban on the index date, were included in this study cohort and their data (for the duration of approximately 7 years observation period, i.e. 2011-2017) available in MDV database was retrospectively observed. Index date was defined as the date of the first prescription of any OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during observation period.
12,262
Total73,989

Baseline characteristics

CharacteristicWarfarinApixabanDabigatranRivaroxabanEdoxabanTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
14590 Participants20038 Participants5594 Participants13859 Participants10811 Participants64892 Participants
Age, Categorical
Between 18 and 65 years
1312 Participants2298 Participants1331 Participants2705 Participants1451 Participants9097 Participants
Race and Ethnicity Not Collected0 Participants
Sex: Female, Male
Female
6257 Participants9131 Participants2184 Participants5818 Participants5331 Participants28721 Participants
Sex: Female, Male
Male
9645 Participants13205 Participants4741 Participants10746 Participants6931 Participants45268 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
deaths
Total, all-cause mortality
0 / 00 / 00 / 00 / 00 / 0
other
Total, other adverse events
0 / 00 / 00 / 00 / 00 / 0
serious
Total, serious adverse events
0 / 00 / 00 / 00 / 00 / 0

Outcome results

Primary

Event Rate Per 100 Participant-Years For First Occurrence of Any Bleeding Event After Index Date

Event rate per 100 participant-years for first occurrence of any bleeding event after index date was reported. Any bleeding was defined using ICD-10 diagnosis codes and participants were considered to have any bleeding if pre-defined bleeding-associated ICD-10 diagnosis codes appeared in the records. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Any Bleeding Event After Index Date22.11 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Bleeding Event After Index Date15.97 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Any Bleeding Event After Index Date15.9 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Bleeding Event After Index Date16.07 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Bleeding Event After Index Date20.34 Events Per 100 Participant-Years
p-value: 0.012795% CI: [0.872, 0.984]Cox proportional hazards model
p-value: 0.289395% CI: [0.881, 1.039]Cox proportional hazards model
p-value: 0.06495% CI: [0.881, 1.004]Cox proportional hazards model
p-value: 0.440495% CI: [0.958, 1.103]Cox proportional hazards model
Primary

Event Rate Per 100 Participant-Years For First Occurrence of Major Bleeding Events After Index Date

Event rate per 100 participant-years for first occurrence of major bleeding event after index date was reported. Major bleeding after index date was identified using hospital claims which had a bleeding diagnosis code as the first listed in International Statistical Classification of Diseases and Related Health Problems (ICD)-10 diagnosis code. An event occurrence of major bleeding was defined as that appears as 21: Disease name behind hospitalization in database. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Major Bleeding Events After Index Date3.13 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Bleeding Events After Index Date1.79 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Major Bleeding Events After Index Date1.72 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Bleeding Events After Index Date1.82 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Bleeding Events After Index Date1.91 Events Per 100 Participant-Years
p-value: <0.000195% CI: [0.614, 0.843]Cox proportional hazards model
p-value: 0.000395% CI: [0.529, 0.825]Cox proportional hazards model
p-value: 0.000795% CI: [0.618, 0.879]Cox proportional hazards model
p-value: 0.001195% CI: [0.583, 0.874]Cox proportional hazards model
Primary

Event Rate Per 100 Participant-Years For First Occurrence of Stroke and Systemic Embolism Events After Index Date

Event rate per 100 participant-years for first occurrence of stroke and systemic embolism events after index date was reported. Stroke events included the composite of any ischemic and any hemorrhagic stroke events (non-traumatic extradural hemorrhage). Systemic embolism events were defined as any of the following: abdominal aortic embolism, aortic embolism, acute arterial occlusive disease of arteries of upper extremities, femoral arterial occlusion and acute arterial occlusive disease of arteries of lower extremities, iliac artery embolism, hepatic artery embolism, thromboembolism, embolic infarction, aortic embolism, subclavian artery stenosis. Index date was defined as date of first prescription of any OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Stroke and Systemic Embolism Events After Index Date3.2 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Stroke and Systemic Embolism Events After Index Date1.67 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Stroke and Systemic Embolism Events After Index Date2.08 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Stroke and Systemic Embolism Events After Index Date1.79 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Stroke and Systemic Embolism Events After Index Date2 Events Per 100 Participant-Years
p-value: <0.000195% CI: [0.558, 0.766]Cox proportional hazards model
p-value: 0.029195% CI: [0.642, 0.977]Cox proportional hazards model
p-value: 0.000195% CI: [0.592, 0.842]Cox proportional hazards model
p-value: 0.001295% CI: [0.591, 0.879]Cox proportional hazards model
Secondary

Event Rate Per 100 Participant-Years For First Occurrence of Any Gastrointestinal Bleeding Event After Index Date

Event rate per 100 participant-years for first occurrence of any gastrointestinal bleeding event after index date was reported. Any gastrointestinal bleeding was defined by ICD-10 diagnosis codes. If participants had ICD-10 diagnosis codes which suggest bleeding from the gastrointestinal tract, they were considered to have any gastrointestinal bleeding. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Any Gastrointestinal Bleeding Event After Index Date5.98 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Gastrointestinal Bleeding Event After Index Date4.11 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Any Gastrointestinal Bleeding Event After Index Date4.75 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Gastrointestinal Bleeding Event After Index Date4.07 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Gastrointestinal Bleeding Event After Index Date5.42 Events Per 100 Participant-Years
Secondary

Event Rate Per 100 Participant-Years For First Occurrence of Any Intracranial Hemorrhage Event After Index Date

Event rate per 100 participant-years for first occurrence of any intracranial hemorrhage event after index date was reported. Any intracranial hemorrhage was defined by ICD-10 diagnosis codes and participants were considered to have any intracranial hemorrhagic event if pre-defined any intracranial hemorrhagic-associated ICD-10 diagnosis codes appeared in the records. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Any Intracranial Hemorrhage Event After Index Date4.16 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Intracranial Hemorrhage Event After Index Date2.93 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Any Intracranial Hemorrhage Event After Index Date2.43 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Intracranial Hemorrhage Event After Index Date2.66 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Any Intracranial Hemorrhage Event After Index Date3.65 Events Per 100 Participant-Years
Secondary

Event Rate Per 100 Participant-Years For First Occurrence of Hemorrhagic Stroke After Index Date

Event rate per 100 participant-years for first occurrence of hemorrhagic stroke after index date was reported. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Hemorrhagic Stroke After Index Date0.72 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Hemorrhagic Stroke After Index Date0.43 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Hemorrhagic Stroke After Index Date0.25 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Hemorrhagic Stroke After Index Date0.36 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Hemorrhagic Stroke After Index Date0.43 Events Per 100 Participant-Years
Secondary

Event Rate Per 100 Participant-Years For First Occurrence of Ischemic Stroke After Index Date

Event rate per 100 participant-years for first occurrence of ischemic stroke after index date was reported. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Ischemic Stroke After Index Date2.4 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Ischemic Stroke After Index Date1.2 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Ischemic Stroke After Index Date1.76 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Ischemic Stroke After Index Date1.41 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Ischemic Stroke After Index Date1.54 Events Per 100 Participant-Years
Secondary

Event Rate Per 100 Participant-Years For First Occurrence of Major Gastrointestinal Bleeding Events After Index Date

Event rate per 100 participant-years for first occurrence of major gastrointestinal bleeding events after index date was reported. Major gastrointestinal bleeding after index date was identified using hospital claims which had a gastrointestinal bleeding diagnosis code as the first listed ICD-10 diagnosis code. An event occurrence of major bleeding was defined as that appears as 21: Disease name behind hospitalization in database. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Major Gastrointestinal Bleeding Events After Index Date1.02 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Gastrointestinal Bleeding Events After Index Date0.61 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Major Gastrointestinal Bleeding Events After Index Date0.77 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Gastrointestinal Bleeding Events After Index Date0.74 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Gastrointestinal Bleeding Events After Index Date0.73 Events Per 100 Participant-Years
Secondary

Event Rate Per 100 Participant-Years For First Occurrence of Major Intracranial Hemorrhage Events After Index Date

Event rate per 100 participant-years for first occurrence of major intracranial hemorrhage events after index date was reported. Major intracranial hemorrhage was defined by ICD-10 diagnosis codes and participants were considered to have major intracranial hemorrhage if pre-defined major intracranial hemorrhagic-associated ICD-10 diagnosis codes appeared in the records. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Major Intracranial Hemorrhage Events After Index Date1.22 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Intracranial Hemorrhage Events After Index Date0.57 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Major Intracranial Hemorrhage Events After Index Date0.43 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Intracranial Hemorrhage Events After Index Date0.5 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Major Intracranial Hemorrhage Events After Index Date0.62 Events Per 100 Participant-Years
Secondary

Event Rate Per 100 Participant-Years For First Occurrence of Systemic Embolism Events After Index Date

Event rate per 100 participant-years for first occurrence of systemic embolism events after index date was reported. Systemic embolism events included any of the following: abdominal aortic embolism, aortic embolism, acute arterial occlusive disease of arteries of upper extremities, femoral arterial occlusion and acute arterial occlusive disease of arteries of lower extremities, iliac artery embolism, hepatic artery embolism, thromboembolism, embolic infarction, aortic embolism, subclavian artery stenosis. Index date was defined as the date of the first prescription of any of OACs (warfarin, apixaban, dabigatran, rivaroxaban or edoxaban) during the observation period of approximately 7 years (2011-2017). Pseudo datasets refers to number derived using IPTW method and are different from the actual participants included in the reporting arm.

Time frame: During the observation period of approximately 7 years

Population: OACs treatment-naive participants diagnosed with NVAF, initiating any OACs treatment were included in study. Analysis performed using IPTW method to balance participant characteristics among reporting groups. IPTW method created weighted pseudo-datasets which were used in analysis of outcome measure and are reported in the units analyzed field.

ArmMeasureValue (NUMBER)
WarfarinEvent Rate Per 100 Participant-Years For First Occurrence of Systemic Embolism Events After Index Date0.11 Events Per 100 Participant-Years
ApixabanEvent Rate Per 100 Participant-Years For First Occurrence of Systemic Embolism Events After Index Date0.04 Events Per 100 Participant-Years
DabigatranEvent Rate Per 100 Participant-Years For First Occurrence of Systemic Embolism Events After Index Date0.08 Events Per 100 Participant-Years
RivaroxabanEvent Rate Per 100 Participant-Years For First Occurrence of Systemic Embolism Events After Index Date0.04 Events Per 100 Participant-Years
EdoxabanEvent Rate Per 100 Participant-Years For First Occurrence of Systemic Embolism Events After Index Date0.05 Events Per 100 Participant-Years

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026