- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03026556
The Comparative Safety and Effectiveness of Dabigatran, Versus Rivaroxaban, and Apixaban Utilized in the Department of Defense Non-Valvular Atrial Fibrillation Patient Population: A Retrospective Database Analysis
Safety and Effectiveness Study Comparing Dabigatran, Rivaroxaban & Apixaban in Non-valvular Atrial Fibrillation Patients Enrolled in the US Department of Defense Military Health System
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
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New Jersey
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Princeton, New Jersey, United States, 08450
- InVentiv Health
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Age 18+ on index date
- Patients must have been prescribed either dabigatran, rivaroxaban, or apixaban identified by pharmacy claim during the study period. The first dispensing date of either study drug will be defined as the index date;
- Patients must be treatment naïve from all OAC use prior to the first NOAC prescription, during study period.
- Patients must have at least 12 months of continuous eligibility prior to the index date;
- Patients must have at least one diagnosis code of atrial fibrillation, defined as International Classification of Diseases (ICD)-9-CM diagnosis of 427.31 or ICD-10-CM diagnosis of I48.0, I48.1, I48.2, I48.91 on the index date or during the pre-index period.
Exclusion Criteria:
Less than 12 months of continuous eligibility in the pre-index period Any claim for OAC drug (oral use only) in the pre-index period Diagnosis of hyperthyroidism during the pre-index period
Having at least one claim for alternative indications; orthopedic procedures, Venous thromboembolism (VTE) (includes deep vein thrombosis (DVT ) & PE)) and the index NOAC prescription at the same time, or, the alternative indication for anticoagulant occurring within 3 months prior to index date in pre-period Having at least one claim with any of the following diagnoses or procedure codes in order to exclude patients with "transient" causes of Afib (3 months prior to index date in pre-period):
- Cardiac surgery
- Pericarditis
- Myocarditis Having at least one medical claim with any of the following diagnoses or procedures codes in order to exclude patients with "valvular" Afib (pre-period):
- Mitral stenosis
- Mitral stenosis with insufficiency
- Mitral valve stenosis and aortic valve stenosis
- Mitral valve stenosis and aortic valve insufficiency
- Diseases of other endocardial structures
- Other and unspecified rheumatic heart diseases
- Open heart valvuloplasty without replacement
- Open and other replacement of unspecified heart valve
- Open and other replacement of aortic valve
- Open and other replacement of mitral valve
- Open and other replacement of pulmonary valve
- Open and other replacement of tricuspid valve
- Heart valve replaced by transplant
- Heart valve replaced by a mechanical device/prosthesis
- Atrioventricular valve repair
- Aortic valve valvuloplasty
- Unlisted procedure, cardiac surgery
- Implantation of catheter-delivered prosthetic aortic heart valve; open thoracic approach
- Transthoracic cardiac exposure (e.g., sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without cardiopulmonary bypass
- Transthoracic cardiac exposure (e.g., sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; with cardiopulmonary bypass
- Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve
- Valvuloplasty, mitral valve, with cardiopulmonary bypass
- Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring
- Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring
- Replacement, mitral valve, with cardiopulmonary bypass
- Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach
- Replacement, pulmonary valve
- Valvectomy, tricuspid valve, with cardiopulmonary bypass
- Valvuloplasty, tricuspid valve; without ring insertion
- Valvuloplasty, tricuspid valve; with ring insertion
- Replacement, tricuspid valve, with cardiopulmonary bypass
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Dabigatran vs. Rivaroxaban
OAC treatment naïve NVAF patients with at least one prescription claim for dabigatran, rivaroxaban (new oral anticoagulant or NOAC).
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observed for 6 years
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Dabigatran vs. Apixaban
OAC treatment naïve NVAF patients with at least one prescription claim for dabigatran, or apixaban (new oral anticoagulant or NOAC).
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Observed for 6 years
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Stroke Overall (Hemorrhagic, Ischemic, Uncertain)
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of overall stroke (hemorrhagic, ischemic, uncertain) in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Length of Follow-up: The post-index follow-up period began the day following the NOAC index date and ended on whichever of the following occurred earliest:
|
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Overall Major Bleeding
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of overall Major bleeding (Hemorrhagic Stroke, Major Intracranial Bleeding and Major Extracranial Bleeding) in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first. |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Ischemic Stroke
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of ischemic stroke in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Hemorrhagic Stroke
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of Hemorrhagic stroke in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first. |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Major Intracranial Bleeding
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of major intracranial bleeding in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Major Extracranial Bleeding
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of major extracranial bleeding (Major GI bleeding, Major urogenital bleeding and Major other bleeding) in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Major GI Bleeding
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of major GI bleeding (Upper GI Bleeding and Lower GI Bleeding) in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Major Urogenital Bleeding
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of major urogenital bleeding in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first. |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Major Other Bleeding
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of major other bleeding in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Upper GI Bleeding
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of Upper GI Bleeding in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Lower GI Bleeding
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of Lower GI Bleeding in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
TIA
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of transient ischemic attack (TIA) in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
All-cause Mortality
Time Frame: Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
The event rate of all-cause mortality in patients matched on propensity scores without index year. Event rates were calculated as the total number of patients in each treatment group who had the outcome during follow-up divided by the total person-years at risk in the cohort. Follow-up time was the time elapsed from the index date to the date of the outcome of interest, disenrollment, end of the observation period (available data), death, discontinuation of the NOAC, or switch to a different NOAC, whichever came first |
Baseline (July 1, 2010) until end of the observation period (June 30, 2016), 6 Years
|
Collaborators and Investigators
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1160-0274
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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