Effectiveness and safety of apixaban and rivaroxaban vs warfarin in patients with atrial fibrillation and chronic kidney disease

作     者：Sylvie Perreault Laurie-Anne Boivin Proulx Aurélie Lenglet Ziad A Massy Marc Dorais 

作者机构：Faculty of PharmacyUniversity of MontrealQuebecMontreal H3C3J7Canada Department of CardiologyFaculty of MedicineUniversity of Ottawa Heart InstituteOntarioOttawa K1Y4W7Canada Department of PharmacyAmiens-Picardie Hospital University CenterAmiens 80000France Faculty of PharmacyMP3CV LaboratoryUR7545University of Picardie Jules VerneAmiens 80000France Division of NephrologyUniversity of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines(UVSQ)VillejuifFrance.AP-HP Ambroise-ParéHospitalBoulogne Billancourt/Paris 92104France StatSciences Inc.Notre-Dame-de-l’Île-PerrotQuebecMontreal J7W 3K8Canada 

出 版 物：《World Journal of Nephrology》 (世界肾病学杂志（英文版）)

年 卷 期：2023年第12卷第5期

页      面：132-146页

学科分类：0202[经济学-应用经济学] 02[经济学] 020205[经济学-产业经济学] 

主　　题：Atrial fibrillation Chronic kidney disease Direct oral anticoagulant Effectiveness Safety Warfarin 

摘      要：BACKGROUND Randomized controlled trials(RCTs)of direct oral anticoagulants(DOACs)included a low proportion of atrial fibrillation(AF)patients with chronic kidney disease(CKD),and suggested that DOACs are safe and effective in patients with mild-to-moderate *** a metanalysis of RCTs and observational studies,DOACs were associated with better efficacy(vs warfarin)in early CKD and had similar efficacy and safety profiles in patients with stages IV-V *** few studies have provided data on the safety and effectiveness of each DOAC vs warfarin in patients with stage III *** effectiveness and safety of DOACs in those patients are still subject to *** To assess and compare the effectiveness and safety of apixaban and rivaroxaban vs warfarin in this patient *** A cohort of patients with an inpatient or outpatient code for AF and stage III CKD who were newly prescribed apixaban and rivaroxaban was created using the administrative databases from the Quebec province of Canada between 2013 and *** primary effectiveness outcome was a composite of ischemic stroke,systemic embolism,and death,whereas the primary safety outcome was a composite of major bleeding within a year of DOAC vs warfarin *** groups were compared in an under-treatment analysis using inverse probability of treatment weighting and Cox proportional *** A total of 8899 included patients filled out a new oral anticoagulation therapy claim;3335 for warfarin and 5564 for *** with warfarin,15 mg and 20 mg rivaroxaban presented a similar effectiveness and safety composite *** 5.0 mg was associated with a lower effectiveness composite risk[Hazard ratio(HR)0.76;95%confidence interval(CI):0.65-0.88]and a similar safety risk(HR 0.94;95%CI:0.66-1.35).Apixaban 2.5 mg was associated with a similar effectiveness composite(HR 1.00;95%CI:0.79-1.26)and a lower safety risk(HR 0.65;95%CI:***,apixaban 5.0 mg was associated with a bet