Dabigatran use cuts risk of S. aureus bacteraemia in AF patients

Among patients with atrial fibrillation (AF), treatment with the direct thrombin inhibitor dabigatran results in a significantly lower incidence of Staphylococcus aureus bacteraemia (SAB) as compared with factor Xa-inhibitors, a study has shown.

The analysis involved 112,537 AF patients (median age, 73 years; 54.8 percent male) who initiated treatment with direct oral anticoagulants. Compared with factor-Xa-inhibitor users, those who used dabigatran were younger, more often men, and had a lower prevalence of comorbidities.

Over a median follow-up of 2 years, 186 dabigatran users and 356 factor Xa-inhibitor users were hospitalized for SAB. The crude incidence rates of bacteraemia were 22.8 and 33.8 events per 10.000 person-years, respectively.

Multivariable Cox regression accounting for time-dynamic changes of exposure status during follow-up revealed dabigatran to be associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio, 0.76, 95 percent confidence interval,0.63–0.93).

The present data indicate that inhibition of the staphylothrombin complex via dabigatran helps reduce the risk of developing SAB and thus support those from preclinical studies, the researchers said. More studies are needed to establish the antibacterial activity of dabigatran against S. aureus infections in humans.

The researchers also stressed that since the study was observational and exploratory in nature, the findings should not be interpreted as dabigatran having an advantage over factor Xa-inhibitors and hence not encourage a change in the choice of anticoagulant therapy in AF.