Effectiveness and Safety of Anticoagulants in Adults with Non-valvular Atrial Fibrillation and Concomitant Coronary/Peripheral Artery Disease
| Autor: | Cristina Masseria, W. Schuyler Jones, Melissa Hamilton, Xianying Pan, Keith Friend, Allison Keshishian, Xiaoyan Li, Onur Baser, Xuemei Luo, Renato D. Lopes, Jack Mardekian, Jan Steffel, Kiran Gupta, Manuela Di Fusco |
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| Přispěvatelé: | University of Zurich, Lopes, Renato D |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Pyridones Embolism Myocardial Infarction Administration Oral Hemorrhage 610 Medicine & health Coronary Artery Disease 2700 General Medicine 030204 cardiovascular system & hematology Medicare Dabigatran Coronary artery disease 03 medical and health sciences Peripheral Arterial Disease 0302 clinical medicine Rivaroxaban Internal medicine Atrial Fibrillation medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Stroke Aged Proportional Hazards Models Retrospective Studies business.industry Warfarin Anticoagulants Atrial fibrillation General Medicine medicine.disease United States Cardiology 10209 Clinic for Cardiology Pyrazoles Apixaban Female business medicine.drug |
| Popis: | Background Direct oral anticoagulants (DOAC) are at least non-inferior to warfarin in efficacy and safety among patients with nonvalvular atrial fibrillation. Limited evidence is available regarding outcomes for nonvalvular atrial fibrillation patients with coronary/peripheral artery disease. Methods Non-valvular atrial fibrillation patients aged ≥65 years diagnosed with coronary/peripheral artery disease in the US Medicare population, newly initiating DOACs (apixaban, rivaroxaban, dabigatran) or warfarin were selected from January 1, 2013 to September 30, 2015. Propensity score matching was used to compare DOACs vs warfarin. Cox proportional hazards models were used to estimate the risk of stroke/systemic embolism, major bleeding, and composite of stroke/myocardial infarction/all-cause mortality. Results There were 15,527 apixaban-warfarin, 6,962 dabigatran-warfarin, and 25,903 rivaroxaban-warfarin–matched pairs, with a mean follow-up of 5-6 months. Compared with warfarin, apixaban was associated with lower rates of stroke/systemic embolism (hazard ratio [HR] 0.48; 95% confidence interval [CI], 0.37-0.62), major bleeding (HR 0.66; 95% CI, 0.58-0.75), and stroke/myocardial infarction/all-cause mortality (HR 0.63; 95% CI, 0.58-0.69); dabigatran and rivaroxaban were associated with lower rates of stroke/myocardial infarction/all-cause mortality (HR 0.79; 95% CI, 0.70-0.90 and HR 0.87; 95% CI, 0.81-0.92, respectively). Rivaroxaban was associated with a lower rate of stroke/systemic embolism (HR 0.72; 95% CI, 0.60-0.89) and a higher rate of major bleeding (HR 1.14; 95% CI, 1.05-1.23) vs warfarin. Conclusions All DOACs were associated with lower stroke/myocardial infarction/all-cause mortality rates compared with warfarin; differences were observed in rates of stroke/systemic embolism and major bleeding. Findings from this observational analysis provide important insights about oral anticoagulation therapy among non-valvular atrial fibrillation patients with coronary/peripheral artery disease and may help physicians in the decision-making process when treating this high-risk group of patients. |
| Databáze: | OpenAIRE |
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