Introduction
Methods
Data source & study design
Ascertainment of exposure and outcome
Ascertainment of baseline covariates
Before Weighting | After Weighting | |||||||
---|---|---|---|---|---|---|---|---|
Variables | DOACs (N = 809) | Warfarin (N = 202) | Absolute standardized difference | DOACs (N = 503) | Warfarin (N = 508) | Absolute standardized difference | ||
Demographics
| ||||||||
Age, mean (SD), y | 84.1 (7.4) | 78.2 (10.3) |
0.66
| 83.1 (6.6) | 82.5 (12.6) | 0.06 | ||
Female sex, No. (%) | 345 (42.7) | 85 (42.1) | 0.01 | 215 (42.7) | 221 (43.6) | 0.02 | ||
Weight, mean (SD), kg | 58.0 (11.1) | 60.7 (12.1) |
0.23
| 58.5 (8.8) | 58.7 (17.5) | 0.02 | ||
eGFR, No. (%) |
0.82
| 0.02 | ||||||
15–29 mL/min | 779 (96.3) | 135 (66.8) | 459 (91.3) | 460 (90.7) | ||||
< 15 mL/min, including dialysisa | 30 (3.7) | 67 (33.2) | 44 (8.7) | 48 (9.4) | ||||
Comorbidities, No. (%)
| ||||||||
CHA2DS2-VASc score, mean (SD) | 4.5 (1.4) | 4.5 (1.7) | 0.04 | 4.5 (1.1) | 4.6 (2.3) | 0.02 | ||
HAS-BLED score, mean (SD) | 3.3 (1.3) | 3.6 (1.3) |
0.25
| 3.3 (1.0) | 3.4 (1.8) | 0.02 | ||
Quan-Charlson Comorbidity Index, mean (SD) | 2.7 (2.2) | 3.0 (2.1) |
0.14
| 2.8 (1.8) | 2.8 (3.5) | 0.01 | ||
Anemia | 108 (13.4) | 36 (17.8) |
0.12
| 70 (13.9) | 58 (11.5) | 0.07 | ||
Asthma | 53 (6.6) | 11 (5.5) | 0.05 | 32 (6.3) | 27 (5.4) | 0.04 | ||
Cancers | 161 (19.9) | 29 (14.4) |
0.15
| 95 (19.0) | 100 (19.8) | 0.02 | ||
Cerebrovascular disease | 270 (33.4) | 64 (31.7) | 0.04 | 165 (32.8) | 182 (35.8) | 0.06 | ||
Congestive heart failure | 394 (48.7) | 95 (47.0) | 0.03 | 245 (48.8) | 246 (48.6) | 0.00 | ||
Myocardial infarction | 33 (4.1) | 20 (9.9) |
0.23
| 23 (4.7) | 25 (5.0) | 0.01 | ||
Peripheral vascular disease | 34 (4.2) | 17 (8.4) |
0.17
| 24 (4.9) | 19 (3.7) | 0.05 | ||
Chronic obstructive pulmonary disorder | 148 (18.3) | 36 (17.8) | 0.01 | 98 (19.5) | 80 (15.8) |
0.10
| ||
Diabetes | 273 (33.8) | 87 (43.1) |
0.19
| 182 (36.2) | 200 (39.4) | 0.07 | ||
Gastrointestinal ulcer | 134 (16.6) | 34 (16.8) | 0.01 | 85 (17.0) | 66 (13.0) |
0.11
| ||
Hypertension | 629 (77.8) | 162 (80.2) | 0.06 | 396 (78.7) | 410 (80.8) | 0.05 | ||
Hyperlipidemia | 215 (26.6) | 69 (34.2) |
0.17
| 144 (28.6) | 152 (30.0) | 0.03 | ||
Liver disease | 65 (8.0) | 22 (10.9) |
0.10
| 42 (8.3) | 45 (8.9) | 0.02 | ||
Prior bleedingb | 203 (25.1) | 44 (21.8) | 0.08 | 122 (24.3) | 112 (22.1) | 0.05 | ||
Smoking |
0.13
| 0.09 | ||||||
Current non-smoker | 756 (93.4) | 191 (94.5) | 474 (94.1) | 484 (95.4) | ||||
Current smoker | 19 (2.4) | 7 (3.5) | 11 (2.2) | 9 (1.8) | ||||
Unknown | 34 (4.2) | 4 (2.0) | 18 (3.7) | 15 (2.8) | ||||
Thyroid Disease | 64 (7.9) | 18 (8.9) | 0.04 | 43 (8.5) | 52 (10.3) | 0.06 | ||
Venous thromboembolism | 16 (2.0) | 3 (1.5) | 0.04 | 10 (2.1) | 18 (3.5) | 0.09 | ||
Medication use, No. (%)
| ||||||||
Antianxiety agents | 220 (27.2) | 65 (32.2) |
0.11
| 143 (28.3) | 131 (25.7) | 0.06 | ||
Antiarrhythmic agents | 220 (27.2) | 65 (32.2) |
0.11
| 140 (27.8) | 142 (28.1) | 0.01 | ||
Anti-depressants | 92 (11.4) | 21 (10.4) | 0.03 | 60 (12.0) | 68 (13.4) | 0.04 | ||
Antiplatelets | 290 (35.9) | 88 (43.6) |
0.16
| 185 (36.8) | 184 (36.3) | 0.01 | ||
Anti-hyperlipidemics | 252 (31.2) | 78 (38.6) |
0.16
| 171 (33.9) | 195 (38.5) | 0.09 | ||
ACEi / ARB | 464 (57.4) | 133 (65.8) |
0.18
| 297 (59.1) | 305 (60.0) | 0.02 | ||
β-Blockers | 442 (54.6) | 116 (57.4) | 0.06 | 276 (54.8) | 284 (56.0) | 0.02 | ||
Calcium channel blockers | 546 (67.5) | 142 (70.3) | 0.06 | 336 (66.8) | 351 (69.2) | 0.05 | ||
Diuretics | 512 (63.3) | 132 (65.4) | 0.04 | 326 (64.7) | 352 (69.3) |
0.10
| ||
Other anti-hypertensives | 104 (12.9) | 45 (22.3) |
0.25
| 67 (13.3) | 61 (12.0) | 0.04 | ||
Insulins | 79 (9.8) | 39 (19.3) |
0.27
| 57 (11.4) | 60 (11.8) | 0.01 | ||
Antidiabetics | 200 (24.7) | 64 (31.7) |
0.16
| 132 (26.3) | 157 (30.9) |
0.10
| ||
NSAIDs | 198 (24.5) | 40 (19.8) |
0.11
| 122 (24.3) | 133 (26.2) | 0.04 | ||
Proton pump inhibitors | 140 (17.3) | 48 (23.8) |
0.16
| 93 (18.4) | 99 (19.4) | 0.03 |
Statistical analysis
Sensitivity and subgroup analyses
Results
Trends of OAC prescription
Baseline patient characteristics
Clinical outcomes
Outcome | DOACs group (n = 503) | Warfarin group (n = 508) | Adjusted HR (95% CI)b | |||||
---|---|---|---|---|---|---|---|---|
Events | PY | Rate (95%CI)a | Events | PY | Rate (95%CI)a | |||
Stroke/SE | 5 | 208 | 2.25 (0.91–5.56) | 17 | 259 | 6.54 (4.06–10.53) | 0.29 (0.09–0.97) | |
Major bleeding | 9 | 208 | 4.33 (2.25–8.33) | 7 | 257 | 2.74 (1.31–5.74) | 0.99 (0.34–2.92) | |
Any ischemia | 17 | 202 | 8.27 (5.12–13.34) | 35 | 248 | 14.18 (10.18–19.74) | 0.42 (0.22–0.79) | |
Any bleeding | 55 | 194 | 28.38 (21.80-36.95) | 65 | 202 | 32.31 (25.33–41.20) | 0.74 (0.50–1.09) |