Dabigatran compared with warfarin in patients with atrial fibrillation and symptomatic heart failure: a subgroup analysis of the RE‐LY trial
- 1 September 2013
- journal article
- research article
- Published by Wiley in European Journal of Heart Failure
- Vol. 15 (9), 1053-1061
- https://doi.org/10.1093/eurjhf/hft111
Abstract
We evaluated the effects of dabigatran compared with warfarin in the subgroup of patients with previous symptomatic heart failure (HF) in the RE-LY trial. RE-LY compared two fixed and blinded doses of dabigatran (110 and 150 mg twice daily) with open-label warfarin in 18 113 patients with AF at increased risk for stroke. Among 4904 patients with HF, annual rates of stroke or systemic embolism (SE) were 1.92% for patients on warfarin compared with 1.90% for dabigatran 110 mg [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.69-1.42] and 1.44% for dabigatran 150 mg (HR 0.75, 95% CI 0.51-1.10). Annual rates of major bleeding were 3.90% for the group on warfarin, compared with 3.26% for dabigatran 110 mg (HR 0.83, 95% CI 0.64-1.09) and 3.10% for dabigatran 150 mg (HR 0.79, 95% CI 0.60-1.03). Rates of intracranial bleeding were significantly lower for both dabigatran dosages compared with warfarin in patients with HF (dabigatran 110 mg vs. warfarin, HR 0.34, 95% CI 0.14-0.80; dabigatran 150 mg vs. warfarin, HR 0.39, 95% CI 0.17-0.89). The relative effects of dabigatran vs. warfarin on the occurrence of stroke or SE and major bleeding were consistent among those with and without HF and those with low (≤40%) or preserved (>40%) LVEF (P interaction not significant). The overall benefits of dabigatran for stroke/SE prevention, and major and intracranial bleeding, relative to warfarin in the RE-LY trial were consistent in patients with and without HF.Keywords
This publication has 30 references indexed in Scilit:
- 2012 focused update of the ESC Guidelines for the management of atrial fibrillationEuropean Heart Journal, 2012
- Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients With Atrial FibrillationJournal of the American College of Cardiology, 2010
- Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)European Heart Journal, 2010
- Twelve‐month outcomes and predictors of very stable INR control in prevalent warfarin usersJournal of Thrombosis and Haemostasis, 2010
- Atrial Fibrillation and Heart Failure in Cardiology Practice: Reciprocal Impact and Combined Management From the Perspective of Atrial Fibrillation: Results of the Euro Heart Survey on Atrial FibrillationJournal of the American College of Cardiology, 2009
- Independent predictors of stroke in patients with atrial fibrillationNeurology, 2007
- Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation: Observations from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) StudyAmerican Heart Journal, 2005
- Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapyThe American Journal of Cardiology, 2003
- The heart failure epidemic: exactly how big is it?Published by Oxford University Press (OUP) ,2001
- Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trialsJournal of the American College of Cardiology, 1998