阿哌沙班
医学
拜瑞妥
华法林
心房颤动
内科学
倾向得分匹配
危险系数
冲程(发动机)
队列
比例危险模型
回顾性队列研究
心脏病学
置信区间
机械工程
工程类
作者
Edouard L Fu,Rishi Desai,Julie M. Paik,Dae Kim,Yichi Zhang,Julianna Mastrorilli,Alexander Cervone,Kueiyu Joshua Lin
标识
DOI:10.1053/j.ajkd.2023.08.017
摘要
Rationale & Objective Head-to-head data comparing the effectiveness and safety of oral anticoagulants in patients with atrial fibrillation (AF) and advanced CKD are lacking. We compared the safety and effectiveness of warfarin or rivaroxaban vs. apixaban in patients with AF and non-dialysis CKD stages 4-5. Study Design Propensity score matched cohort study. Setting & Participants: Two nationwide U.S. claims databases, Medicare and Optum’s de-identified Clinformatics® Data Mart Database (01/01/2013-03/31/2022). New initiators of warfarin vs. apixaban (N = 12,488) and rivaroxaban vs. apixaban (N = 5720) with nonvalvular AF and CKD stage 4-5. Exposures Warfarin, rivaroxaban or apixaban. Outcomes Primary outcomes included major bleeding and ischemic stroke. Secondary outcomes included all-cause mortality, major gastrointestinal bleeding, and intracranial bleeding. Analytical approach Cox regression was used to estimate hazard ratios (HR) and 1:1 propensity score matching was used to adjust for 80 potential confounders. Results Compared with apixaban, warfarin initiation was associated with a higher rate of major bleeding (HR 1.85; 95% CI 1.59-2.15), including major gastrointestinal bleeding (1.86; 1.53-2.25) and intracranial bleeding (2.15; 1.42-3.25). Rivaroxaban vs. apixaban was also associated with a higher rate of major bleeding (1.69; 1.33-2.15). All-cause mortality was similar for warfarin (1.08; 0.98-1.18) or rivaroxaban (0.94; 0.81-1.10) vs. apixaban. Furthermore, no statistically significant differences for ischemic stroke were observed for warfarin (1.14; 0.83-1.57) or rivaroxaban (0.71; 0.40-1.24) vs. apixaban, although confidence intervals were wide. Similar results were observed for warfarin vs. apixaban in the positive control cohort of patients with CKD stage 3, consistent with randomized trial findings. Limitations Few ischemic stroke events, potential residual confounding. Conclusions In patients with AF and advanced CKD, rivaroxaban and warfarin were associated with a higher rate of major bleeding compared with apixaban, suggesting a superior safety profile for apixaban in this high-risk population.
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