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Comparative Effectiveness and Safety of Oral Anticoagulants Across Kidney Function in Patients With Atrial Fibrillation.
- Source :
- Circulation: Cardiovascular Quality & Outcomes; Oct2020, Vol. 13 Issue 10, pe006515-e006515, 1p
- Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>Patients with atrial fibrillation and severely decreased kidney function were excluded from the pivotal non-vitamin K antagonist oral anticoagulants (NOAC) trials, thereby raising questions about comparative safety and effectiveness in patients with reduced kidney function. The study aimed to compare oral anticoagulants across the range of kidney function in patients with atrial fibrillation.<bold>Methods and Results: </bold>Using a US administrative claims database with linked laboratory data, 34 569 new users of oral anticoagulants with atrial fibrillation and estimated glomerular filtration rate ≥15 mL/(min·1.73 m2) were identified between October 1, 2010 to November 29, 2017. The proportion of patients using NOACs declined with decreasing kidney function-73.5%, 69.6%, 65.4%, 59.5%, and 45.0% of the patients were prescribed a NOAC in estimated glomerular filtration rate ≥90, 60 to 90, 45 to 60, 30 to 45, 15 to 30 mL/min per 1.73 m2 groups, respectively. Stabilized inverse probability of treatment weighting was used to balance 4 treatment groups (apixaban, dabigatran, rivaroxaban, and warfarin) on 66 baseline characteristics. In comparison to warfarin, apixaban was associated with a lower risk of stroke (hazard ratio [HR], 0.57 [0.43-0.75]; P<0.001), major bleeding (HR, 0.51 [0.44-0.61]; P<0.001), and mortality (HR, 0.68 [0.56-0.83]; P<0.001); dabigatran was associated with a similar risk of stroke but a lower risk of major bleeding (HR, 0.57 [0.43-0.75]; P<0.001) and mortality (HR, 0.68 [0.48-0.98]; P=0.04); rivaroxaban was associated with a lower risk of stroke (HR, 0.69 [0.51-0.94]; P=0.02), major bleeding (HR, 0.84 [0.72-0.99]; P=0.04), and mortality (HR, 0.73 [0.58-0.91]; P=0.006). There was no significant interaction between treatment and estimated glomerular filtration rate categories for any outcome. When comparing one NOAC to another NOAC, there was no significant difference in mortality, but some differences existed for stroke or major bleeding. No relationship between treatments and falsification end points was found, suggesting no evidence for substantial residual confounding.<bold>Conclusions: </bold>Relative to warfarin, NOACs are used less frequently as kidney function declines. However, NOACs appears to have similar or better comparative effectiveness and safety across the range of kidney function. [ABSTRACT FROM AUTHOR]
- Subjects :
- ATRIAL fibrillation diagnosis
CHRONIC kidney failure
PROTEINS
GLOMERULAR filtration rate
DATABASES
PYRIDINE
RESEARCH
KIDNEYS
ORAL drug administration
WARFARIN
TIME
HETEROCYCLIC compounds
RESEARCH methodology
ANTICOAGULANTS
ATRIAL fibrillation
RETROSPECTIVE studies
MEDICAL cooperation
EVALUATION research
MEDICAL care research
RISK assessment
TREATMENT effectiveness
COMPARATIVE studies
RESEARCH funding
HEMORRHAGE
Subjects
Details
- Language :
- English
- ISSN :
- 19417713
- Volume :
- 13
- Issue :
- 10
- Database :
- Supplemental Index
- Journal :
- Circulation: Cardiovascular Quality & Outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 146601389
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.120.006515