Original Comparison of clinical effects and costs among dabigatran etexilate, rivaroxaban and warfarin in elderly patients with atrial fibrillation

Objective: To analyze the clinical effects and economic costs between Warfarin and novel oral anticoagulants in elderly patients with atrial fibrillation (AF). Methods: This is a retrospective study. A total of 680 elderly AF patients receiving oral anticoagulants for the first time were selected as subjects and assigned into Group A, B and C. Patients in group A, B and C were given dabigatran etexilate, rivaroxaban and warfarin, respectively. Patients were followed up for 2 years. This study compared indicators of left ventricular diastolic function such as left ventricular posterior wall in end-diastole (LVPWd), minimum peak velocity in early diastole phase and maximum peak velocity in late diastole phase, indicators of myocardial ischemia including creatine kinase isoenzyme, lactate dehydrogenase (LDH) and myoglobin, as well as other outcomes including adverse events incidences and treatment costs, among the three groups. Results: After treatment, LVPWd was found to be obviously lower in group A and group B than that in group C, while the minimum peak velocity in early diastole phase was markedly more in group A and B than that in group C (all P<0.05). In addition, the concentrations of myoglobin and LDH were significantly reduced in group A and B than those in group C (all P<0.05). The occurrence rate of adverse events was significantly lower in group A and B than that in group C (P<0.05). Moreover, treatment cost was markedly less in group A and B than that in group C (P<0.05). Conclusion: Compared with warfarin, dabigatran etexilate and rivaroxaban not only have the ability to inhibit the myocardial ischemia indicators and improve left ventricular diastolic function while reducing the incidence of adverse events, but they also offer certain cost-effectiveness advantages for elderly patients with AF.