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Comparative Effectiveness of Dabigatran, Rivaroxaban, Apixaban, and Warfarin in the Management of Patients With Nonvalvular Atrial Fibrillation

Pink, J. and Pirmohamed, M. and Hughes, D.A. (2013) Comparative Effectiveness of Dabigatran, Rivaroxaban, Apixaban, and Warfarin in the Management of Patients With Nonvalvular Atrial Fibrillation. Clinical Pharmacology & Therapeutics. DOI: 10.1038/clpt.2013.83

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Abstract

Alternative anticoagulants to warfarin (dabigatran, rivaroxaban, and apixaban) are becoming available for the prevention of thromboembolic stroke in atrial fibrillation (AF), but there is a lack of information on their comparative effectiveness. Using a discrete event simulation method adopting a lifetime horizon of analysis, we made an indirect comparison of the RE-LY, ROCKET-AF, and ARISTOTLE trial results for AF patients in the US population. Over a lifetime, apixaban, dabigatran, and rivaroxaban accrued 0.130 (95% central range (CR) �0.030 to 0.264), 0.106 (95% CR �0.048 to 0.248), and 0.095 (95% CR �0.052 to 0.242) more quality-adjusted life-years (QALYs), respectively, than warfarin, with apixaban having a 55% probability of accruing the highest total QALYs. In the absence of a definitive trial, and acknowledging the limitations of an indirect comparison, the available evidence suggests apixaban to be the most effective anticoagulant.

Item Type: Article
Subjects: Research Publications
Departments: College of Health and Behavioural Sciences > North Wales Centre for Primary Care Research
Date Deposited: 09 Dec 2014 16:43
Last Modified: 23 Sep 2015 03:07
ISSN: 0009-9236
URI: http://e.bangor.ac.uk/id/eprint/886
Identification Number: DOI: 10.1038/clpt.2013.83
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