Wang, Zixuan, Matthewman, Julian, Tazare, John, Yu, Qiuyan, Cheung, Ka Shing, Chui, Celine S. L., Chan, Esther W. Y., Bhaskaran, Krishnan, Smeeth, Liam, Wong, Ian C. K., Douglas, Ian J. and Wong, Angel Y. S. (2024). Risk of mortality between warfarin and direct oral anticoagulants: population-based cohort studies. BMC Medicine, 22 (1),
Abstract
Background: Direct oral anticoagulants (DOACs) have been reported to be associated with a higher risk of mortality compared with an older alternative, warfarin using primary care data in the United Kingdom (UK). However, other studies observed contradictory findings. We therefore aimed to investigate the association between mortality and warfarin, compared with DOACs. Methods: We conducted cohort studies using UK Clinical Practice Research Datalink (CPRD) Aurum and Hong Kong Clinical Data Analysis and Reporting System (CDARS) to identify the association between warfarin and hazard of mortality, compared to DOACs. Individuals with non-valvular atrial fibrillation aged ≥ 18 years who had first anticoagulant therapy (warfarin or DOAC) during 1/1/2011–31/12/2019 were included. Results: Compared with DOAC use, a lower hazard of all-cause mortality was found in warfarin users (hazard ratio (HR) = 0.81, 95% confidence interval (CI) = 0.77–0.86) in CPRD; while a higher hazard was observed in warfarin users (HR = 1.31, 95% CI = 1.24–1.39) in CDARS, versus DOAC users. In our exploratory analysis, consistent results were seen in both databases when stratified warfarin users by time in therapeutic range (TTR) using post-baseline measurements: a lower hazard of all-cause mortality in warfarin users with TTR ≥ 65% (CPRD: HR = 0.68, 95% CI = 0.65–0.72; CDARS: HR = 0.86, 95% CI = 0.77–0.96) and increased hazard in warfarin users with TTR < 65% (CPRD: HR = 1.14, 95% CI = 1.05–1.23; CDARS: HR = 1.59, 95% CI = 1.50–1.69), versus DOAC users. Conclusions: The differences in hazard of all-cause mortality associated with warfarin compared with DOAC, in part may depend on anticoagulation control in warfarin users. Notably, this study is unable to establish a causal relationship between warfarin and mortality stratified by TTR, versus DOACs, requiring future studies for further investigation.
Publication DOI: | https://doi.org/10.1186/s12916-024-03808-y |
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Divisions: | College of Health & Life Sciences > Aston Pharmacy School |
Funding Information: | This study is supported by the Laboratory of Data Discovery for Health (D24H) funded by AIR@InnoHK administered by Innovation and Technology Commission, the Government of the Hong Kong Special Administrative Region, China. |
Additional Information: | Copyright © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ |
Uncontrolled Keywords: | Direct anticoagulant,Warfarin,Mortality |
Publication ISSN: | 1741-7015 |
Last Modified: | 27 Mar 2025 08:11 |
Date Deposited: | 07 Jan 2025 18:37 |
Full Text Link: | |
Related URLs: |
https://bmcmedi ... 916-024-03808-y
(Publisher URL) http://www.scop ... tnerID=8YFLogxK (Scopus URL) |
PURE Output Type: | Article |
Published Date: | 2024-12 |
Published Online Date: | 2024-12-23 |
Accepted Date: | 2024-12-02 |
Authors: |
Wang, Zixuan
Matthewman, Julian Tazare, John Yu, Qiuyan Cheung, Ka Shing Chui, Celine S. L. Chan, Esther W. Y. Bhaskaran, Krishnan Smeeth, Liam Wong, Ian C. K. ( ![]() Douglas, Ian J. Wong, Angel Y. S. |