Comparative effectiveness of dabigatran, rivaroxaban, and edoxaban on cardiac and renal outcomes in Asian patients with atrial fibrillation: a propensity score-weighted analysis

Atrial fibrillation (AF) significantly increases stroke and systemic embolism risk. Direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, and edoxaban offer superior pharmacokinetic profiles compared to warfarin. However, comparative effectiveness data on mortality and renal outcomes, especially in Asian populations, remain limited.

This retrospective, multi-center observational study analyzed data from three Taiwanese hospitals, encompassing 4,392 adult AF patients (July 2013-December 2020) treated with dabigatran (n=803), rivaroxaban (n=2,834), or edoxaban (n=755). Two-year follow-up assessed all-cause mortality, cardiovascular mortality, renal failure, acute kidney injury (AKI), and ≥30% estimated glomerular filtration rate (eGFR) decline. Propensity score weighting addressed confounding biases.

Compared to dabigatran, rivaroxaban and edoxaban showed significantly higher all-cause mortality risks (rivaroxaban HR 1.76, 95% CI 1.320-2.342, p<0.0001; edoxaban HR 1.55, 95% CI 1.081-2.218, p=0.0171). Dabigatran also demonstrated superior renal protection, with rivaroxaban and edoxaban exhibiting significantly higher risks of renal failure (rivaroxaban HR 1.66, 95% CI 1.079-2.538, p=0.0210; edoxaban HR 1.80, 95% CI 1.075-3.012, p=0.0254). No significant differences in major bleeding were observed across DOACs after propensity score adjustment.

This real-world study supports dabigatran's superior efficacy in reducing mortality and renal failure risk among Asian AF patients compared to rivaroxaban and edoxaban.