Abstract | BACKGROUND: METHODS AND RESULTS: Using US MarketScan claims data from November 2011 to December 2016, we identified frail oral anticoagulant-naïve nonvalvular atrial fibrillation patients with ≥12 months of continuous insurance coverage before oral anticoagulant initiation. Frailty status was determined using the Johns Hopkins Claims-based Frailty Indicator score (≥0.20 indicating frailty). Users of apixaban, dabigatran, or rivaroxaban were separately 1:1 matched to warfarin users via propensity-scores, with residual absolute standardized differences <0.1 being achieved for all covariates after matching. Patients were followed for up to 2 years or until an event, insurance disenrollment or end of follow-up. Rates of stroke or systemic embolism and major bleeding were compared using Cox regression and reported as hazard ratios (HRs) and 95% confidence intervals (CIs). In total, 2700, 2784, and 5270 patients were included in the apixaban, dabigatran, and rivaroxaban 1:1 matched analyses to warfarin. At 2 years, neither apixaban nor dabigatran were associated with differences in the hazard of stroke or systemic embolism (HR=0.78; 95% CI=0.46-1.35 and HR=0.94; 0.60-1.45) or major bleeding (HR=0.72; 95% CI=0.49-1.06 and HR=0.87; 95% CI=0.63-1.19) versus warfarin. Rivaroxaban was associated with reduced stroke or systemic embolism at 2 years (HR=0.68; 95% CI=0.49-0.95) without significantly altering major bleeding risk (HR=1.07; 95% CI=0.81-1.32). CONCLUSIONS:
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Authors | Brandon K Martinez, Nitesh A Sood, Thomas J Bunz, Craig I Coleman |
Journal | Journal of the American Heart Association
(J Am Heart Assoc)
Vol. 7
Issue 8
(04 13 2018)
ISSN: 2047-9980 [Electronic] England |
PMID | 29654196
(Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
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Copyright | © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. |
Chemical References |
- Anticoagulants
- Factor Xa Inhibitors
- Pyrazoles
- Pyridones
- apixaban
- Warfarin
- Rivaroxaban
- Dabigatran
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Topics |
- Administration, Oral
- Aged
- Aged, 80 and over
- Anticoagulants
(administration & dosage)
- Atrial Fibrillation
(complications, drug therapy, physiopathology)
- Dabigatran
(administration & dosage)
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Factor Xa Inhibitors
(administration & dosage)
- Female
- Follow-Up Studies
- Frail Elderly
- Humans
- Incidence
- Male
- Pyrazoles
(administration & dosage)
- Pyridones
(administration & dosage)
- Retrospective Studies
- Rivaroxaban
(administration & dosage)
- Stroke
(epidemiology, etiology, prevention & control)
- Time Factors
- Treatment Outcome
- United States
(epidemiology)
- Warfarin
(administration & dosage)
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