A retrospective cohort study of the effectiveness and safety of dabigatran versus rivaroxaban in overweight patients with nonvalvular atrial fibrillation.

BACKGROUND

Guidance for dabigatran and rivaroxaban in overweight patients diagnosed with non-valvular atrial fibrillation (NVAF) is still lacking.

AIM

Compare the effectiveness and safety of dabigatran and rivaroxaban for the treatment of NVAF in the overweight population.

METHOD

A total of 396 out of 1029 overweight patients with NVAF at Zhongshan Hospital, Fudan University, from January 2017 and December 2018 were retrospectively enrolled using propensity score matching analysis. The clinical outcomes were analyzed by chi-square test and Kaplan-Meier analyses. The risk of bleeding and thrombosis was assessed using a Cox regression analysis and validated using a nomogram model.

RESULTS

In terms of effectiveness, the incidence of thrombosis events and the time to thrombosis were similar in the dabigatran and rivaroxaban groups (P > 0.05). Regarding safety, compared to dabigatran, the rivaroxaban group had a higher incidence of bleeding events (8.6% vs. 3.5%, χ = 4.435, P = 0.035), a shorter time to bleeding (11.3 ± 0.18 months vs. 11.6 ± 0.14 months, P = 0.038) and an increased risk of bleeding (hazard ratio HR = 2.452, 95% confidence interval CI 1.017-5.913, P = 0.046), especially in those patients with heart failure (HR = 3.207, 95% CI 1.183-8.694, P = 0.022).

CONCLUSION

Dabigatran therapy was shown to be equally effective. It may be superior in reducing bleeding risk in an overweight population with NVAF than rivaroxaban. Further prospective studies are encouraged for analysis.