Comparing Dabigatran, Apixaban, and Rivaroxaban in the Absence of Head-to-Head Trials

U.S. clinicians have a choice of four direct-acting oral anticoagulants (DOACs), but head-to-head trials are lacking. In this observational study, Mayo Clinic researchers used an insurance database to compare effectiveness and safety of the three most-commonly prescribed DOACs (dabigatran [Pradaxa], apixaban [Eliquis], and rivaroxaban [Xarelto]) in patients with nonvalvular atrial fibrillation. Using propensity-score matching, demographically and clinically similar cohorts were created for each two-way comparison: The rivaroxaban–dabigatran comparison had 15,800 patients in each group, and the apixaban–dabigatran and apixaban–rivaroxaban comparisons had about 6500 patients in each group. Results were published in two separate articles.

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