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Original research article
Direct oral anticoagulation and mortality in moderate to high-risk atrial fibrillation
  1. Ronen Arbel1,
  2. Ruslan Sergienko2,
  3. Ariel Hammerman3,
  4. Sari Dotan-Greenberg3,
  5. Erez Batat3,
  6. Orly Avnery4,
  7. Dan Greenberg2,
  8. Martin H Ellis4
  1. 1Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel
  2. 2School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
  3. 3Clalit Health Services Headquarters, Tel Aviv, Israel
  4. 4Hematology Institute and BloodBank, Meir Medical Center, Kfar Saba, Israel
  1. Correspondence to Dr Ronen Arbel, Sapir College, Hof Ashkelon 79165, Israel; ronen.arbel{at}gmail.com

Abstract

Objective Although direct oral anticoagulants (DOAC) are the recommended antithrombotic therapy for patients with non-valvular atrial fibrillation (NVAF), anticoagulation in patients with NVAF is still inadequate. The effect of withholding DOAC therapy on patient survival is unknown. Therefore, our objective was to compare all-cause mortality rates between DOAC-treated patients with NVAF and similar patients receiving no anticoagulation.

Methods We performed a retrospective cohort study analysing Clalit Health Services’ extensive electronic database, regarding all newly diagnosed, anticoagulant-naïve patients with NVAF who were eligible for DOAC therapy from 1 January 2011 to 31 December 2016. Patients who received DOAC therapy were matched by propensity scoring to patients receiving no anticoagulation. The primary outcome was all-cause mortality. Final patient follow-up date was 15 May 2017.

Results 18 901 eligible patients were identified. 8298 received treatment with a DOAC and 10 603 received no anticoagulation therapy. Of those, 5657 patients who received DOAC therapy were matched with 5657 patients who did not receive any anticoagulant. Death occurred in 715 patients in the DOAC-treated group (7.6% per year) and in 2075 patients in the non-anticoagulated patient group (11.1% per year). DOAC therapy was associated with significantly lower risk for all-cause mortality (HR=0.69, 95% CI 0.63 to 0.75, p<0.001). The benefit of DOAC therapy was demonstrated across all subgroups analysed.

Conclusions In this cohort of newly diagnosed patients with NVAF, DOAC therapy was associated with a significantly lower risk of death compared with no oral anticoagulation. Our findings provide further evidence for the importance of providing DOAC anticoagulation in patients with NVAF.

  • atrial fibrillation
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Footnotes

  • Contributors RA: conception of the research; drafting the manuscript for critically important intellectual content; interpretation of data. RS: data analysis; revising the manuscript for critically important intellectual content. AH: conception of the research; acquisition of data; drafting the manuscript for critically important intellectual content; interpretation of data. SDG: conception of the research; revising the manuscript for critically important intellectual content. EB: conception of the research; acquisition of data. OA and MHE: interpretation of data; revising the manuscript for critically important intellectual content. DG: conception of the research; securing the funding for the research; revising the manuscript for critically important intellectual content.

  • Funding This study was supported in part by a non-restricted grant from the Israeli National Institute for Health Policy Research (Grant No 029-13).

  • Competing interests None declared.

  • Ethics approval The study was approved by Clalit Health Services’s (CHS) data extraction committee and ethical approval was provided by the Institutional Review Board of CHS.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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