Comparison of clinical outcomes of edoxaban versus apixaban, dabigatran, rivaroxaban, and vitamin K antagonists in patients with atrial fibrillation in Germany: A real-world cohort study

Published:November 12, 2021DOI:


      • Edoxaban is a factor X inhibitor approved for stroke prevention in AF patients.
      • The real-world data from AF patients receiving Edoxaban is limited.
      • The risk of ischemic stroke was lower for patients receiving edoxaban.
      • Major bleeding was similar for patients receiving edoxaban, apixaban, or dabigatran.
      • Edoxaban provides stroke prevention while maintaining favorable safety.



      The aim of the study was to compare the real-world effectiveness and safety in atrial fibrillation (AF) patients treated with edoxaban versus other oral anticoagulants (OACs) (apixaban, dabigatran, rivaroxaban, and vitamin K antagonists [VKA]) in Germany.

      Methods and results

      Using a representative database of 3.5 million statutory health-insured lives in Germany, a retrospective cohort study was conducted to examine ischemic stroke (IS) or systemic embolism (SE) and major bleeding in AF patients initiating anticoagulant therapy from January 2014 through June 2017. Inverse probability of treatment weighting using propensity score was applied for baseline covariate adjustment. Cox proportional hazards models were used to estimate the adjusted risk (hazard ratio [HR]) of each outcome comparing edoxaban versus other OACs.
      Among 21,038 patients treated with OACs, 1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA patients were included. The adjusted combined risks of IS or SE were lower (p < 0.05) for each edoxaban pairwise comparison with other OACs (HR: 0.83 vs. apixaban, 0.60 vs. dabigatran, 0.72 vs. rivaroxaban, 0.64 vs. VKA). Edoxaban favored lower risks of major bleeding compared with rivaroxaban (HR: 0.74) and VKA (HR: 0.47). No differences in the risk of major bleeding were found between edoxaban and apixaban (p = 0.33), and between edoxaban and dabigatran (p = 0.06).


      Edoxaban was associated with better effectiveness compared with other OACs in AF patients from Germany. Edoxaban also demonstrated a favorable safety profile.



      Abbreviation (Description), ACEI (Angiotensin Converting Enzyme Inhibitors), AF (Atrial Fibrillation), AIDS (Acquired Immunodeficiency Syndrome), ARB (Angiotensin Receptor Blockers), DVT (Deep Vein Thrombosis), ED (Emergency Department), ESRD (End-Stage Renal Disease), GFL (Gesundheitsforen Leipzig GmbH), HCRU (Healthcare Resource Utilization), HIV (Human Immunodeficiency Virus), HR (Hazard Ratio), INR (International Normalized Ratio), IPTW (Inverse Probability Treatment Weight), IS (Ischemic Stroke), NOAC (Non-VKA Oral Anticoagulant), NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), OAC (Oral Anticoagulant), PE (Pulmonary Embolism), SE (Systemic Embolism), TBI (Traumatic Brain Injury), VKA (Vitamin K Antagonists), VTE (Venous Thromboembolism)
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