{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T22:13:52Z","timestamp":1783030432908,"version":"3.54.6"},"reference-count":59,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T00:00:00Z","timestamp":1725235200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Vitamin\u2010K antagonists (VKAs) have widely been replaced by non\u2010VKA oral anticoagulants (NOACs). This includes Austria, Germany and Switzerland, where as VKA, instead of warfarin, the much longer\u2010acting phenprocoumon is used, which was not compared to NOACs in clinical trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using administrative data from a large German health insurance, we included all anticoagulation\u2010na\u00efve patients with a first prescription of a NOAC or VKA between 2012 and 2020. We analysed overall survival, major adverse cardiac and cerebrovascular events, major thromboembolic events and major bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 570,137 patients were included (apixaban: 26.9%, dabigatran: 4.6%, edoxaban: 8.8%, rivaroxaban: 39.1% and VKA: 20.7% of these 99.4% phenprocoumon). In the primary analysis using a 1:1 propensity score matching\u2010cohort (PSM\u2010cohort), a significantly higher overall mortality was found for apixaban, edoxaban and rivaroxaban (all <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.001) but not for dabigatran (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.13) compared to VKA. In this PSM\u2010cohort, 5\u2010year mortality was 22.7% for apixaban versus 12.7% for VKA, 19.5% for edoxaban versus 11.4% for VKA, 16.0% for rivaroxaban versus 12.3% for VKA (all <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001) and 13.0% for dabigatran versus 12.8% for VKA (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.06). The observed effect was confirmed in sensitivity analyses using un\u2010weighted and three different weighted Fine\u2013Gray regression models on the basis of the entire cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this large real\u2010world analysis, apixaban, edoxaban and rivaroxaban, but not dabigatran, were associated with worse survival compared to VKA. These findings, consistent with a few other studies including phenprocoumon, cast profound doubts on the unreflected, general use of NOACs. Randomized trials should assess whether phenprocoumon might actually be superior to NOACs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.20006","type":"journal-article","created":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T11:59:21Z","timestamp":1725278361000},"page":"362-376","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Apixaban, edoxaban and rivaroxaban but not dabigatran are associated with higher mortality compared to vitamin\u2010K antagonists: A retrospective German claims data analysis"],"prefix":"10.1111","volume":"296","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2685-5117","authenticated-orcid":false,"given":"Christiane","family":"Engelbertz","sequence":"first","affiliation":[{"name":"Department of Cardiology I \u2013 Coronary and Peripheral Vascular Disease, Heart Failure University Hospital Muenster  Muenster 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