Warfarin vs NOACs for AF – dead men (and women) do tell tales …

German researchers have recently compared real-world effectiveness and safety of non-vitamin-K-antagonist oral anticoagulant (NOAC) treatment for patients with atrial fibrillation (AF) against warfarin. This retrospective analysis examined defintive outcomes including all-cause mortality, ischemic strokes, non-specified strokes, TIAs, MIs, arterial embolism, hemorrhagic strokes, and severe bleeds. Main comparisons were done based on propensity score-matched (PSM) cohorts. Results were reported as incidence rate ratios and hazard ratios (HRs). There were 37,439 AF patients to assigned each PSM cohort (NOAC cohort: mean age 78.2 years, mean CHA₂DS₂VASc score 2.96, mean follow-up 348.5 days; Vitamin K Antagonist cohort: mean age 78.2 years, mean CHA₂DS₂VASc 2.95, mean follow-up 365.5 days). NOAC exposure was associated with significantly higher incidence rate ratios for all-cause death, ischaemic stroke, non-specified strokes, TIAs, MIs, arterial embolism and severe bleeding. Multivariable Cox regression analyses and additional sensitivity analysis, including analysis of PSM-matched NOAC/VKA treatment-naive patients, confirmed these results. The results of this study appear to be at odds with the findings of subsequent research. The reasons for this remain unclear … see details of the study here