Safety and Efficacy of Novel Oral Anticoagulants Versus Warfarin in Medicare Beneficiaries With Atrial Fibrillation and Valvular Heart Disease

被引:29
作者
Briasoulis, Alexandros [1 ]
Inampudi, Chakradhari [1 ]
Akintoye, Emmanuel [1 ]
Alvarez, Paulino [1 ]
Panaich, Sidakpal [1 ]
Vaughan-Sarrazin, Mary [2 ,3 ]
机构
[1] Univ Iowa Hosp & Clin, Sect Heart Failure & Transplant, Div Cardiovasc Dis, Iowa City, IA 52242 USA
[2] Univ Iowa, Iowa City, IA USA
[3] Iowa City VA Med Ctr, Comprehens Access & Delivery Res & Evaluat Ctr, Iowa City, IA USA
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2018年 / 7卷 / 08期
关键词
anticoagulation; atrial fibrillation arrhythmia; valvular disease; ANTITHROMBOTIC THERAPY; EUROPEAN-SOCIETY; PROPENSITY SCORE; DABIGATRAN; STROKE; RIVAROXABAN; PREDICTORS; ADJUSTMENT; MANAGEMENT; APIXABAN;
D O I
10.1161/JAHA.118.008773
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-We examined a large community-based sample of patients with atrial fibrillation (AF) and valvular heart disease (VHD) (excluding prosthetic valves) with a goal to compare outcomes among patients with AF, with and without VHD, taking warfarin, dabigatran, and rivaroxaban. Methods and Results-We identified Medicare beneficiaries enrolled in Medicare Part D benefit plan from 2011 to 2013 with newly diagnosed AF (18 137 patients with VHD [dabigatran, 1979; rivaroxaban, 2027; warfarin, 14 131] and 85 596 patients without VHD [dabigatran, 13 522; rivaroxaban, 14 257; warfarin, 57 817]). Primary outcomes of all-cause mortality, ischemic strokes, major bleeding, and myocardial infarction were compared across the 3 anticoagulants using 3-way propensity-matched samples. After propensity matching, a total of 5871 patients with VHD and 40 221 patients without VHD and AF were studied. Both dabigatran and rivaroxaban were associated with significantly lower risk of death in patients with VHD with AF (dabigatran versus warfarin: hazard ratio, 0.71; 95% confidence interval, 0.52-0.98; P=0.038; rivaroxaban versus warfarin: hazard ratio, 0.68; 95% confidence interval, 0.49-0.95; P=0.022). Nongastrointestinal bleeding was significantly reduced with dabigatran and rivaroxaban versus warfarin in those with VHD (dabigatran versus warfarin: hazard ratio, 0.17; 95% confidence interval, 0.06-0.49; P 0.001; rivaroxaban versus warfarin: hazard ratio, 0.37; 95% confidence interval, 0.17-0.84; P 0.017). Ischemic stroke and gastrointestinal bleeding rates did not differ between rivaroxaban, dabigatran, and warfarin in patients with VHD. The effects of the 3 anticoagulants on outcomes were comparable in patients with and without VHD and with AF. Conclusions-In this cohort of Medicare beneficiaries with VHD (excluding patients with prosthetic valves) and new-onset AF between 2011 and 2013, novel oral non-vitamin K anticoagulants were safe and effective options for prevention of systemic thromboembolism.
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页数:23
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共 31 条
  • [1] Methods for evaluation of medication adherence and persistence using automated databases
    Andrade, Susan E.
    Kahler, Kristijan H.
    Frech, Feride
    Chan, K. Arnold
    [J]. PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2006, 15 (08) : 565 - 574
  • [2] Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples
    Austin, Peter C.
    [J]. STATISTICS IN MEDICINE, 2009, 28 (25) : 3083 - 3107
  • [3] Apixaban in Comparison With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Findings From the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Trial
    Avezum, Alvaro
    Lopes, Renato D.
    Schulte, Phillip J.
    Lanas, Fernando
    Gersh, Bernard J.
    Hanna, Michael
    Pais, Prem
    Erol, Cetin
    Diaz, Rafael
    Cecilia Bahit, M.
    Bartunek, Jozef
    De Caterina, Raffaele
    Goto, Shinya
    Ruzyllo, Witold
    Zhu, Jun
    Granger, Christopher B.
    Alexander, John H.
    [J]. CIRCULATION, 2015, 132 (08) : 624 - 632
  • [4] Clinical characteristics and outcomes with rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trial
    Breithardt, Gunter
    Baumgartner, Helmut
    Berkowitz, Scott D.
    Hellkamp, Anne S.
    Piccini, Jonathan P.
    Stevens, Susanna R.
    Lokhnygina, Yuliya
    Patel, Manesh R.
    Halperin, Jonathan L.
    Singer, Daniel E.
    Hankey, Graeme J.
    Hacke, Werner
    Becker, Richard C.
    Nessel, Christopher C.
    Mahaffey, Kenneth W.
    Fox, Keith A. A.
    Califf, Robert M.
    [J]. EUROPEAN HEART JOURNAL, 2014, 35 (47) : 3377 - 3385
  • [5] Propensity Score Methods for Confounding Control in Nonexperimental Research
    Brookhart, M. Alan
    Wyss, Richard
    Layton, J. Bradley
    Stuerner, Til
    [J]. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2013, 6 (05): : 604 - 611
  • [6] Brown Joshua D, 2016, J Manag Care Spec Pharm, V22, P1319
  • [7] Dabigatran versus Warfarin in Patients with Atrial Fibrillation.
    Connolly, Stuart J.
    Ezekowitz, Michael D.
    Yusuf, Salim
    Eikelboom, John
    Oldgren, Jonas
    Parekh, Amit
    Pogue, Janice
    Reilly, Paul A.
    Themeles, Ellison
    Varrone, Jeanne
    Wang, Susan
    Alings, Marco
    Xavier, Denis
    Zhu, Jun
    Diaz, Rafael
    Lewis, Basil S.
    Darius, Harald
    Diener, Hans-Christoph
    Joyner, Campbell D.
    Wallentin, Lars
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (12) : 1139 - 1151
  • [8] Dealing with limited overlap in estimation of average treatment effects
    Crump, Richard K.
    Hotz, V. Joseph
    Imbens, Guido W.
    Mitnik, Oscar A.
    [J]. BIOMETRIKA, 2009, 96 (01) : 187 - 199
  • [9] Dabigatran versus Warfarin in Patients with Mechanical Heart Valves
    Eikelboom, John W.
    Connolly, Stuart J.
    Brueckmann, Martina
    Granger, Christopher B.
    Kappetein, Arie P.
    Mack, Michael J.
    Blatchford, Jon
    Devenny, Kevin
    Friedman, Jeffrey
    Guiver, Kelly
    Harper, Ruth
    Khder, Yasser
    Lobmeyer, Maximilian T.
    Maas, Hugo
    Voigt, Jens-Uwe
    Simoons, Maarten L.
    Van de Werf, Frans
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2013, 369 (13) : 1206 - 1214
  • [10] Comorbidity measures for use with administrative data
    Elixhauser, A
    Steiner, C
    Harris, DR
    Coffey, RN
    [J]. MEDICAL CARE, 1998, 36 (01) : 8 - 27