--- title: "Dabigatran vs warfarin - atrial fibrillation: clinical pract | Sutter Health" description: "In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but, particularly among the elderly, a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial." url: "https://www.sutterhealth.org/research/publications/dabigatran-vs-warfarin-atrial-fibrillation-1055312522" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Dabigatran vs warfarin - atrial fibrillation: clinical pract # Dabigatran versus warfarin for atrial fibrillation in real-world clinical practice: a systematic review and meta-analysis. Romanelli RJ, Nolting L, Dolginsky M, Kym E, & Orrico KB. _Circ Cardiovasc Qual Outcomes. pii: CIRCOUTCOMES.115.002369. \[Epub ahead of print\]_ 2016-01-26 ## Abstract BACKGROUND: Trial data for the benefits and risks of dabigatran versus warfarin in the treatment of nonvalvular atrial fibrillation are lacking. We sought to review real-world observational evidence for the comparative effectiveness and safety of these agents. METHODS AND RESULTS: A systematic search of multiple databases was conducted from first available date to March 10, 2015 for longitudinal, observational studies comparing dabigatran with warfarin. Two reviewers evaluated studies for eligibility and extracted hazard ratios for ischemic stroke and gastrointestinal and intracranial bleeding. hazard ratios were pooled using random-effects meta-analysis. Metaregression was performed to assess treatment-effect heterogeneity. We identified 232 unique citations. Seven retrospective cohort studies met study eligibility criteria, with 348 750 patients and a mean follow-up of 2.2 years. In pooled analyses, dabigatran-150 mg was not superior to warfarin in preventing stroke (hazard ratio, 0.92; 95% confidence interval, 0.84-1.01; P=0.066), but had a significantly lower hazard of intracranial bleeding (0.44; 0.34-0.59; P<0.001). Dabigatran-150 mg had a significantly greater hazard of gastrointestinal bleeding than warfarin (1.23; 1.01-1.50; P=0.041), which was potentiated in studies of older (elderly) versus younger populations (median/mean age, ≥75 versus <75 years; β=1.53; 95% confidence interval, 1.10-2.14; P=0.020). CONCLUSIONS: In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but, particularly among the elderly, a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/26812933) ## Research topics - [Aging and Longevity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Aging+and+Longevity%5C%22%22) - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Cerebrovascular Disorders](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cerebrovascular+Disorders%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Statin dosing instructions, medication adherence, and low-density lipoprotein cholesterol: a cohort study of incident statin users.](https://www.sutterhealth.org/research/publications/cohort-study-of-incident-statin-users-1055312767) Marcum ZA, Huang HC, Romanelli RJ. J Gen Intern Med. doi: 10.1007/s11606-019-05180-7. \[Epub ahead of print\] 2019 Jul 31 - Publication ### [Comparative usability study of a newly created patient-centered tool and Medicare.gov plan finder to help Medicare beneficiaries choose prescription drug plans.](https://www.sutterhealth.org/research/publications/pt-centered-drug-plan-finder-vs-medicaregov-1055312687) Stults CD, Fattahi S, Meehan A, Bundorf MK, Chan AS, Pun T, Tai-Seale M. J Patient Exp. 6(1):81-86. doi: 10.1177/2374373518778343. Epub 2018 Jun 6. 2019 Mar 01 - Publication ### [Health behavior change after blood pressure feedback.](https://www.sutterhealth.org/research/publications/health-beh-change-after-bp-feedbk-1055312958) Pu J, Chewning BA, Johnson HM, Vanness DJ, Young HN, Kreling DH. PLoS One. 10(10):e0141217. doi: 10.1371/journal.pone.0141217. eCollection 2015. 2015 Oct 26 - Publication ### [Patients' medication-related experience of care is associated with adherence to cardiometabolic disease therapy in real-world clinical practice.](https://www.sutterhealth.org/research/publications/pt-experience-of-care-associated-with-cmd-tx-adherence-1055312299) Romanelli RJ, Huang Q, LaMori J, Doshi D, Chung S. Popul Health Manag. doi: 10.1089/pop.2017.0163. \[Epub ahead of print\] 2018 Mar 12 - Publication ### [Pharmacist-led medication management program within a patient-centered medical home.](https://www.sutterhealth.org/research/publications/pharmacist-led-medication-management-in-pcmh-1055312959) Romanelli RJ, Leahy A, Jukes T, Ishisaka DY. Am J Health Syst Pharm. 72(6):453-9. doi: 10.2146/ajhp140487. 2015 Mar 15 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/dabigatran-vs-warfarin-atrial-fibrillation-1055312522#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Dabigatran vs warfarin - atrial fibrillation: clinical pract"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/dabigatran-vs-warfarin-atrial-fibrillation-1055312522#medicalscholarlyarticle","name":"Dabigatran versus warfarin for atrial fibrillation in real-world clinical practice: a systematic review and meta-analysis.","headline":"Dabigatran vs warfarin - atrial fibrillation: clinical pract","abstract":"BACKGROUND: Trial data for the benefits and risks of dabigatran versus warfarin in the treatment of nonvalvular atrial fibrillation are lacking. We sought to review real-world observational evidence for the comparative effectiveness and safety of these agents. METHODS AND RESULTS: A systematic search of multiple databases was conducted from first available date to March 10, 2015 for longitudinal, observational studies comparing dabigatran with warfarin. Two reviewers evaluated studies for eligibility and extracted hazard ratios for ischemic stroke and gastrointestinal and intracranial bleeding. hazard ratios were pooled using random-effects meta-analysis. Metaregression was performed to assess treatment-effect heterogeneity. We identified 232 unique citations. Seven retrospective cohort studies met study eligibility criteria, with 348 750 patients and a mean follow-up of 2.2 years. In pooled analyses, dabigatran-150 mg was not superior to warfarin in preventing stroke (hazard ratio, 0.92; 95% confidence interval, 0.84-1.01; P=0.066), but had a significantly lower hazard of intracranial bleeding (0.44; 0.34-0.59; P\u003c0.001). Dabigatran-150 mg had a significantly greater hazard of gastrointestinal bleeding than warfarin (1.23; 1.01-1.50; P=0.041), which was potentiated in studies of older (elderly) versus younger populations (median/mean age, ≥75 versus \u003c75 years; β=1.53; 95% confidence interval, 1.10-2.14; P=0.020). CONCLUSIONS: In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but, particularly among the elderly, a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial.","description":"In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but, particularly among the elderly, a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial.","keywords":["Aging and Longevity","Cardiovascular Diseases","Cerebrovascular Disorders","Disease Management","Medical Informatics"],"datePublished":"2016-01-26","url":"https://www.sutterhealth.org/research/publications/dabigatran-vs-warfarin-atrial-fibrillation-1055312522","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"26812933"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/26812933/"],"isPartOf":{"@type":"Periodical","name":"Circ Cardiovasc Qual Outcomes"},"author":[{"@type":"Person","name":"Romanelli RJ"},{"@type":"Person","name":"Nolting L"},{"@type":"Person","name":"Dolginsky M"},{"@type":"Person","name":"Kym E"},{"@type":"Person","name":"Orrico KB"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Aging and Longevity","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Aging+and+Longevity%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Cardiovascular Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cardiovascular+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Cerebrovascular Disorders","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cerebrovascular+Disorders%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/dabigatran-vs-warfarin-atrial-fibrillation-1055312522","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/dabigatran-vs-warfarin-atrial-fibrillation-1055312522#breadcrumblist"}}} ```