医学
华法林
心房颤动
肾功能
倾向得分匹配
内科学
冲程(发动机)
阿哌沙班
回顾性队列研究
心脏病学
比例危险模型
观察研究
低风险
队列研究
拜瑞妥
置信区间
工程类
机械工程
作者
Min Jun,Anish Scaria,Jason G. Andrade,Sunil V. Badve,Peter Birks,Sarah E. Bota,Anna Campain,Ognjenka Djurdjev,Amit X. Garg,Jeffrey Ha,Ziv Harel,Brenda R. Hemmelgarn,Carinna Hockham,Matthew T. James,Meg Jardine,Adeera Levin,Eric McArthur,Pietro Ravani,Selena Shao,Manish M. Sood,Zhi Tan,Navdeep Tangri,Reid Whitlock,Martin Gallagher
出处
期刊:European Heart Journal - Quality of Care and Clinical Outcomes
[Oxford University Press]
日期:2022-10-27
卷期号:9 (6): 621-631
被引量:5
标识
DOI:10.1093/ehjqcco/qcac069
摘要
Abstract Aims The aim of this study was to determine the comparative effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in adults with atrial fibrillation (AF) by level of kidney function. Methods and results We pooled findings from five retrospective cohorts (2011–18) across Australia and Canada of adults with; a new dispensation for a DOAC or warfarin, an AF diagnosis, and a measure of baseline estimated glomerular filtration rate (eGFR). The outcomes of interest, within 1 year from the cohort entry date, were: (1) the composite of all-cause death, first hospitalization for ischaemic stroke, or transient ischaemic attack (effectiveness), and (2) first hospitalization for major bleeding defined as an intracranial, upper or lower gastrointestinal, or other bleeding (safety). Cox models were used to examine the association of a DOAC vs. warfarin with outcomes, after 1:1 matching via a propensity score. Kidney function was categorized as eGFR ≥60, 45–59, 30–44, and <30 mL/min/1.73 m2. A total of 74 542 patients were included in the matched analysis. DOAC initiation was associated with greater or similar effectiveness compared with warfarin initiation across all eGFR categories [pooled HRs (95% CIs) for eGFR categories: 0.74(0.69–0.79), 0.76(0.54–1.07), 0.68(0.61–0.75) and 0.86(0.76–0.98)], respectively. DOAC initiation was associated with lower or similar risk of major bleeding than warfarin initiation [pooled HRs (95% CIs): 0.75(0.65–0.86), 0.81(0.65–1.01), 0.82(0.66–1.02), and 0.71(0.52–0.99), respectively). Associations between DOAC initiation, compared with warfarin initiation, and study outcomes were not modified by eGFR category. Conclusion DOAC use, compared with warfarin use, was associated with a lower or similar risk of all-cause death, ischaemic stroke, and transient ischaemic attack and also a lower or similar risk of major bleeding across all levels of kidney function.