Limited real-world data are available on the survival of patients treated with vitamin
K antagonists (VKAs) versus with direct oral anticoagulants (DOACs) for nonvalvular
atrial fibrillation (AF). In this nationwide registry, we analyzed the mortality risk
of patients with nonvalvular AF taking DOACs versus VKAs, with a special attention
to the early treatment period.The Hungarian National Health Insurance Fund (NHIF)
database was searched to identify patients treated with VKA or DOAC as a thromboembolic
prophylaxis for nonvalvular AF between 2011 and 2016. The overall and the early (0-3,
4-6, and 7-12 months) mortality risks with the 2 types of anticoagulation were compared.
A total of 144,394 patients with AF treated with either a VKA (n = 129,925) or a DOAC
(n = 14,469) were enrolled.A 28% improvement in 3-year survival with DOAC treatment
compared with VKA treatment was shown. Mortality reduction with DOACs was consistent
across different subgroups. However, younger patients (30-59 years old) initiated
on DOAC therapy had the greatest RRR (53%) in mortality. Furthermore, DOAC treatment
also yielded a benefit of greater magnitude (HR = 0.55; 95% CI, 0.40-0.77, P = 0.001)
in the lower (0-1) CHA2DS2-VASc score segment and in those with fewer (0-1) bleeding
risk factors (HR = 0.50, CI 0.34-0.73, P = 0.001). The RRR in mortality with DOACs
was 33% within the first 3 months, and 6% in the second year.Thromboembolic prophylaxis
with DOACs in this study yielded significantly lower mortality compared with VKA treatment
in patients with nonvalvular AF. The largest benefit was shown in the early period
after treatment initiation, as well as in younger patients, those with a lower CHA2DS2-VASc
score, and those with fewer bleeding risk factors.
