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Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study

BACKGROUND: We previously conducted a retrospective cohort study using chart review of oral anticoagulant-naïve Japanese patients with nonvalvular atrial fibrillation (NVAF) that assessed the risk of major bleeding and stroke/systemic embolism (SE) events of apixaban versus warfarin. METHODS: In thi...

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Autores principales: Morimoto, Takeshi, Hoshino, Haruhiko, Matsuo, Yukako, Ibuki, Tatsuki, Miyata, Kayoko, Koretsune, Yukihiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625512/
https://www.ncbi.nlm.nih.gov/pubmed/37847442
http://dx.doi.org/10.1007/s40256-023-00611-7
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author Morimoto, Takeshi
Hoshino, Haruhiko
Matsuo, Yukako
Ibuki, Tatsuki
Miyata, Kayoko
Koretsune, Yukihiro
author_facet Morimoto, Takeshi
Hoshino, Haruhiko
Matsuo, Yukako
Ibuki, Tatsuki
Miyata, Kayoko
Koretsune, Yukihiro
author_sort Morimoto, Takeshi
collection PubMed
description BACKGROUND: We previously conducted a retrospective cohort study using chart review of oral anticoagulant-naïve Japanese patients with nonvalvular atrial fibrillation (NVAF) that assessed the risk of major bleeding and stroke/systemic embolism (SE) events of apixaban versus warfarin. METHODS: In this subgroup analysis, we compared the risk of major bleeding and stroke/SE events by stratifying patients into four subgroups matched 1:1 using propensity score matching (PSM) according to baseline creatinine clearance (CrCl; mL/min): ≥ 15 to < 30, ≥ 30 to < 50, ≥ 50 to < 80, and ≥ 80. RESULTS: Of the 7074 patients in the apixaban group and 4998 in the warfarin group eligible for inclusion in the analysis, 4385 were included in each group after PSM. Incidence rates of major bleeding and stroke/SE events were generally lower with apixaban versus warfarin across the CrCl subgroups. When all patients with a CrCl change of < 0 mL/min per year during the study period (apixaban, n = 3871; warfarin, n = 2635) were stratified into four subgroups based on the magnitude of CrCl decline (median CrCl change [mL/min] per year: − 1.09, − 3.48, − 7.54, and − 36.92 for apixaban, and − 1.10, − 3.65, − 7.85, and − 40.40 for warfarin), the incidence rates of major bleeding and stroke/SE events generally increased with an increasing CrCl decline per year in both groups. CONCLUSIONS: In Japanese patients with NVAF, the safety and effectiveness of apixaban and warfarin were consistent across different renal subgroups, including those with severe renal impairment. Our results highlight the importance of monitoring renal function variations over time in patients with NVAF. CLINICALTRIALS.GOV IDENTIFIER: NCT03765242. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40256-023-00611-7.
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spelling pubmed-106255122023-11-06 Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study Morimoto, Takeshi Hoshino, Haruhiko Matsuo, Yukako Ibuki, Tatsuki Miyata, Kayoko Koretsune, Yukihiro Am J Cardiovasc Drugs Original Research Article BACKGROUND: We previously conducted a retrospective cohort study using chart review of oral anticoagulant-naïve Japanese patients with nonvalvular atrial fibrillation (NVAF) that assessed the risk of major bleeding and stroke/systemic embolism (SE) events of apixaban versus warfarin. METHODS: In this subgroup analysis, we compared the risk of major bleeding and stroke/SE events by stratifying patients into four subgroups matched 1:1 using propensity score matching (PSM) according to baseline creatinine clearance (CrCl; mL/min): ≥ 15 to < 30, ≥ 30 to < 50, ≥ 50 to < 80, and ≥ 80. RESULTS: Of the 7074 patients in the apixaban group and 4998 in the warfarin group eligible for inclusion in the analysis, 4385 were included in each group after PSM. Incidence rates of major bleeding and stroke/SE events were generally lower with apixaban versus warfarin across the CrCl subgroups. When all patients with a CrCl change of < 0 mL/min per year during the study period (apixaban, n = 3871; warfarin, n = 2635) were stratified into four subgroups based on the magnitude of CrCl decline (median CrCl change [mL/min] per year: − 1.09, − 3.48, − 7.54, and − 36.92 for apixaban, and − 1.10, − 3.65, − 7.85, and − 40.40 for warfarin), the incidence rates of major bleeding and stroke/SE events generally increased with an increasing CrCl decline per year in both groups. CONCLUSIONS: In Japanese patients with NVAF, the safety and effectiveness of apixaban and warfarin were consistent across different renal subgroups, including those with severe renal impairment. Our results highlight the importance of monitoring renal function variations over time in patients with NVAF. CLINICALTRIALS.GOV IDENTIFIER: NCT03765242. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40256-023-00611-7. Springer International Publishing 2023-10-17 2023 /pmc/articles/PMC10625512/ /pubmed/37847442 http://dx.doi.org/10.1007/s40256-023-00611-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research Article
Morimoto, Takeshi
Hoshino, Haruhiko
Matsuo, Yukako
Ibuki, Tatsuki
Miyata, Kayoko
Koretsune, Yukihiro
Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study
title Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study
title_full Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study
title_fullStr Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study
title_full_unstemmed Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study
title_short Safety and Effectiveness of Apixaban Versus Warfarin in Japanese Patients with Nonvalvular Atrial Fibrillation Stratified by Renal Function: A Retrospective Cohort Study
title_sort safety and effectiveness of apixaban versus warfarin in japanese patients with nonvalvular atrial fibrillation stratified by renal function: a retrospective cohort study
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625512/
https://www.ncbi.nlm.nih.gov/pubmed/37847442
http://dx.doi.org/10.1007/s40256-023-00611-7
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