Comparison of Low and Full Dose Apixaban Versus Warfarin in Patients With Atrial Fibrillation and Renal Dysfunction (from a National Registry).

Autor: Gurevitz C; Department of Cardiology, Beilinson Campus, Rabin Medical Center, Petah-Tikva, Israel. Electronic address: chenmor69@gmail.com., Giladi E; Department of Internal Medicine 'C', Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Barsheshet A; Department of Cardiology, Beilinson Campus, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Klempfner R; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Cardiac Rehabilitation Institute, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel., Goldenberg I; Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York., Kornowski R; Department of Cardiology, Beilinson Campus, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Elis A; Department of Internal Medicine 'C', Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2021 Nov 15; Vol. 159, pp. 87-93. Date of Electronic Publication: 2021 Sep 07.
DOI: 10.1016/j.amjcard.2021.08.022
Abstrakt: The use of direct oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) is robust. However, the efficacy and safety of different dosage in patients with renal dysfunction is still a clinical challenge. We aimed to evaluate the clinical characteristics and outcomes of patients treated with apixaban in its different doses. A multicenter prospective cohort study, where consecutive eligible apixaban or warfarin treated patients with NVAF and renal impairment, were registered. Patients were followed-up for clinical events over a mean period of 1 year. Analyses were performed according to the dose of apixaban given, with consideration to the standard indications for dose reduction. Primary outcome was a composite of 1-year mortality, stroke or systemic embolism, major bleeding and myocardial infarction, while secondary outcomes included those components separated. Among the study population (n = 2,140), risk of composite outcome was significantly lower in the high dose apixaban group (10%, n = 491) than the low dose group (18%, n = 673) and the warfarin group (18%, n = 976) p <0.001. Results of 1-year mortality were similar. Apixaban dosing analysis revealed 65% of patients were appropriately dosed, while 31% were under-dosed and 4% were over-dosed. Furthermore, 53% of patients treated with low dose apixaban were under-dosed. Propensity score analysis revealed that patients who were appropriately treated with low-dose apixaban had a trend towards better composite outcome and mortality than 1:1 matched warfarin treated patients (18% vs 24%, p = 0.09 and 16% vs 23%, p = 0.06, respectively). Overall, appropriately dosed apixaban treated patients at any dose had significantly better outcomes than matched warfarin treated patients (composite outcome probability of 13.1% vs 18.6%, p = 0.007). In conclusion, apixaban at any dose is a reasonable alternative to warfarin in patients with renal impairment, possibly associated with improved outcomes.
Competing Interests: Disclosures Ilan Goldenberg reports financial support was provided by Pfizer Inc. Ilan Goldenberg reports a relationship with Pfizer Inc that includes: funding grants. Alon Barsheshet and Robert Klempfner have received speaker honoraria from Boehringer Ingelheim, Pfizer, and Bayer.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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