Comparative Effectiveness and Safety of Direct Oral Anticoagulants vs Warfarin among Nursing Home Residents with Atrial Fibrillation: A Retrospective Cohort Study.
Hemalkumar B Mehta, Xuya Xiao, Huijun An and 1 others
PMID 39370117WHAT IT FOUND
In nursing home residents with atrial fibrillation, DOACs and warfarin had similar risks of stroke and major bleeding.
However, residents starting DOACs had a lower risk of death from any cause during follow-up.
Key findings
01There was no statistically significant difference between DOAC and warfarin use regarding the risk of ischemic stroke, systemic embolism, or major bleeding.
02DOAC use was associated with a lower risk of all-cause death compared to warfarin.
03When comparing individual drugs, dabigatran was associated with a higher risk of stroke or systemic embolism, while rivaroxaban was associated with a lower risk, compared to warfarin.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study could not control for frailty or over-the-counter aspirin use, which may have influenced outcomes. The analysis for dabigatran had relatively few stroke events, making that specific comparison less reliable. Results may not apply to residents with Medicare Advantage insurance. The study did not evaluate the effect of different drug doses. Data relied on administrative claims, which may contain coding errors.
Declared interests
All authors report no conflicts of interest.
The easy way to misread this
Do not assume all DOACs are equivalent. While the class overall showed similar stroke risk to warfarin, dabigatran specifically was associated with a higher risk of stroke or systemic embolism in this analysis.