1. Stroke, Bleeding, and Mortality Risks in Elderly Medicare Beneficiaries Treated with Dabigatran or Rivaroxaban for Nonvalvular Atrial Fibrillation

2. Dabigatran vs Rivaroxaban for Nonvalvular Atrial Fibrillation: Study Objectives
To compare risks of thromboembolic stroke, intracranial hemorrhage, major extracranial bleeding including major gastrointestinal bleeding, and mortality in patients with nonvalvular AF who initiated dabigatran or rivaroxaban treatment for stroke prevention
How does rivaroxaban compare with dabigatran for stroke, bleeding, and mortality risks in patients with atrial fibrillation?
Graham DJ et al. JAMA Intern Med. doi: /jamainternmed

3. Dabigatran vs Rivaroxaban for Nonvalvular Atrial Fibrillation: Study Design
Retrospective new user cohort study of 118,891 patients with nonvalvular AF who were 65 years or older, enrolled in fee-for-service Medicare, and who initiated treatment with dabigatran or rivaroxaban from November 4, 2011, through June 30, 2014
The data analysis was performed from May 7, 2015, through June 30, 2016
Graham DJ et al. JAMA Intern Med. doi: /jamainternmed

4. Dabigatran vs Rivaroxaban for Nonvalvular Atrial Fibrillation: Treatment Effects
Thromboembolic Stroke
Intracranial Hemorrhage
0.6
0.6
Dabigatran
Rivaroxaban
0.4
0.4
Cumulative Adjusted Incidence Rate, %
Rivaroxaban
Cumulative Adjusted Incidence Rate, %
0.2
0.2
Dabigatran 60
120
180
240
300 60
120
180
240
300
Follow-up Time, d
Follow-up Time, d
Weighted No. at Risk
Weighted No. at Risk
Dabigatran Rivaroxaban
52264
66630
26729
35707
13355
19527
9236
12947
6156
8511
4384
5753
Dabigatran Rivaroxaban
52264
66630
26729
35707
13355
19527
9236
12947
6156
8511
4384
5753
Graham DJ et al. JAMA Intern Med. doi: /jamainternmed

5. Dabigatran vs Rivaroxaban for Nonvalvular Atrial Fibrillation: Treatment Effects
Major Gastrointestinal Bleeding
Death
2.5
2.0
Rivaroxaban
Rivaroxaban
2.0
1.5
1.5
Cumulative Adjusted Incidence Rate, %
Cumulative Adjusted Incidence Rate, %
1.0
1.0
Dabigatran
Dabigatran
0.5
0.5 60
120
180
240
300 60
120
180
240
300
Follow-up Time, d
Follow-up Time, d
Weighted No. at Risk
Weighted No. at Risk
Dabigatran Rivaroxaban
52264
66630
26729
35707
13355
19527
9236
12947
6156
8511
4384
5753
Dabigatran Rivaroxaban
52264
66630
26729
35707
13355
19527
9236
12947
6156
8511
4384
5753
Graham DJ et al. JAMA Intern Med. doi: /jamainternmed

6. Dabigatran vs Rivaroxaban for Nonvalvular Atrial Fibrillation: Study Results
Rivaroxaban 20mg once daily was associated with statistically significant increases in the risk of ICH and major extracranial bleeding, including major gastrointestinal bleeding compared with dabigatran 150mg twice daily
In patients 75 years or older or with CHADS2 score greater than 2, rivaroxaban use was associated with significantly increased mortality compared with dabigatran use
Graham DJ et al. JAMA Intern Med. doi: /jamainternmed

7. Dabigatran vs Rivaroxaban for Nonvalvular Atrial Fibrillation: Summary
In this observational study, rivaroxaban use was associated with increased intracranial and major extracranial bleeding events compared with dabigatran use. The excess rate of ICH with rivaroxaban use exceeded its reduced rate of thromboembolic stroke
Graham DJ et al. JAMA Intern Med. doi: /jamainternmed