Deprivation and inequalities lead to worse outcomes with dabigatran etexilate

Abstract

INTRODUCTION: Dabigatran etexilate is now prescribed for 51% of the patients receiving oral anticoagulation treatment in New Zealand. Its prescribing trends in relation to patient outcomes are, however, largely unknown for these patients. AIM: To describe patient characteristics, effectiveness and safety of treatment with dabigatran etexilate in the New Zealand population. METHODS: This retrospective cohort study used administrative health data for patients dispensed dabigatran etexilate between 1 July 2011 and 31 December 2015. Adverse events (haemorrhage) and treatment failure (thromboembolism or cerebrovascular accident) data were extracted and linked to patient-specific demographic data. Baseline patient characteristics were analysed with descriptive statistics to examine trends in dabigatran etexilate prescribing. Raw and adjusted hazard ratios (HRs), including covariates, were derived using Cox proportional hazard models. RESULTS: In total, 52,413 patients were dispensed dabigatran etexilate. Multivariate analysis indicated the risk of haemorrhagic events were significantly increased for Māori (HR and 95% Confidence Interval (CI): 2.10 (1.54-2.86)) and Pacific Peoples (HR = 2.20 (1.49-3.24)); those aged >80 years (HR = 1.25 (1.08-1.43)); and more deprived populations in quintile 4 (HR = 1.24 (1.08-1.43)) and quintile 5 (HR = 1.30 (1.12-1.50)). There was an increased risk of thromboembolism and cerebrovascular accident among people aged >80 years (HR = 1.79 (1.49-2.15)). DISCUSSION: Demographic factors are associated with adverse outcomes in patients treated with dabigatran etexilate. Targeted strategies are needed to prescribe dabigatran etexilate more appropriately in these populations.