Rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and stage IV-V chronic kidney disease
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Date
2020Journal
American Heart JournalPublisher
Mosby Inc.Type
Article
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Background: There is limited evidence on the effectiveness and safety of direct-acting oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF) and advanced chronic kidney disease (CKD). This study compared the risks of ischemic stroke/systemic embolism (ISSE) and major bleeding in patients with NVAF and stage IV-V CKD treated with rivaroxaban or warfarin. Methods: Patients with NVAF and stage IV-V CKD who initiated rivaroxaban or warfarin treatment between November 2011 and June 2018 were selected from the Optum® Deidentified Electronic Health Record Database. Propensity score matching was used to balance rivaroxaban and warfarin patients on 112 measured baseline covariates. ISSE and major bleeding events over 2 years following treatment initiation were ascertained with validated end point definitions. Outcomes were analyzed as time-to-event data using Kaplan-Meier survival estimators and Cox regression. Results: A total of 781 eligible rivaroxaban-treated patients were propensity score-matched to 1,536 warfarin-treated patients; baseline covariates were well balanced after matching (absolute standardized differences <0.1). The average patient age was 80 years; 60.5% were female; 81.3% and 18.7% had CKD stage IV and V, respectively. Hazard ratios for rivaroxaban compared to warfarin were 0.93 (95% CI 0.46-1.90, P =.85) for the risk of ISSE and 0.91 (95% CI 0.65-1.28, P =.60) for major bleeding. Conclusions: No statistically significant difference in the risk of ISSE or major bleeding was found between rivaroxaban- and warfarin-treated patients. Although further study is needed, rivaroxaban appears to be a reasonable alternative to warfarin for ISSE prevention in the setting of NVAF and stage IV-V CKD. Copyright 2020 The AuthorsSponsors
Janssen Pharmaceuticals; Janssen Biotech; American Historical Association, AHAKeyword
Atrial FibrillationEmbolism
Renal Insufficiency, Chronic
Risk Factors
Rivaroxaban--therapeutic use
Stroke
Warfarin--therapeutic use
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https://www.scopus.com/inward/record.uri?eid=2-s2.0-85079888279&doi=10.1016%2fj.ahj.2020.01.010&partnerID=40&md5=2f64a5dbbb2098b2338246b311e06ab8; http://hdl.handle.net/10713/12157ae974a485f413a2113503eed53cd6c53
10.1016/j.ahj.2020.01.010