拜瑞妥
医学
阿哌沙班
心房颤动
冲程(发动机)
内科学
危险系数
心脏病学
队列
瓣膜性心脏病
栓塞
心力衰竭
华法林
置信区间
机械工程
工程类
作者
Ghadeer K. Dawwas,Adam Cuker,Geoffrey D. Barnes,James D. Lewis,Sean Hennessy
摘要
Background: Although apixaban and rivaroxaban are commonly used in patients with atrial fibrillation (AF) and valvular heart disease (VHD), there is limited evidence comparing the 2 drugs in these patients. Objective: To emulate a target trial of effectiveness and safety of apixaban and rivaroxaban in patients with AF and VHD. Design: New-user, active comparator, cohort study design. Setting: Commercial health insurance database from 1 January 2013 to 31 December 2020. Patients: New users of apixaban or rivaroxaban who had a diagnosis of AF and VHD before initiation of anticoagulant therapy. Measurements: The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of gastrointestinal or intracranial bleeding. Cox proportional hazards regression with a robust variance estimator was used to estimate hazard ratios (HRs) and 95% CIs. Results: When compared with rivaroxaban in a propensity score–matched cohort of 19 894 patients (9947 receiving each drug), apixaban was associated with a lower rate of ischemic stroke or systemic embolism (HR, 0.57 [95% CI, 0.40 to 0.80]) and bleeding (HR, 0.51 [CI, 0.41 to 0.62]). The absolute reduction in the probability of stroke or systemic embolism with apixaban compared with rivaroxaban was 0.0026 within 6 months and 0.011 within 1 year of treatment initiation. The absolute reduction in the probability of bleeding events with apixaban compared with rivaroxaban was 0.012 within 6 months and 0.019 within 1 year of treatment initiation. Limitation: Short follow-up time and inability to ascertain some types of VHD. Conclusion: In this study of patients with AF and VHD, patients receiving apixaban had a lower risk for ischemic stroke or systemic embolism and for bleeding when compared with those receiving rivaroxaban. Primary Funding Source: National Institutes of Health.
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