Cargando…

The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data

Several observational studies have compared apixaban with rivaroxaban in patients with non-valvular atrial fibrillation (NVAF), but these analyses may be confounded by unmeasured characteristics. This study used provider prescribing preference (PPP) as an instrumental variable (IV) to assess the ass...

Descripción completa

Detalles Bibliográficos
Autores principales: Atreja, Nipun, Severtson, Stevan Geoffrey, Jiang, Jenny, Gao, Chuan, Hines, Dionne M., Cheng, Dong, Hagan, Melissa, Breeze, Janis L., Paulus, Jessica K., Secemsky, Eric A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10671855/
https://www.ncbi.nlm.nih.gov/pubmed/38002802
http://dx.doi.org/10.3390/jcm12227190
_version_ 1785149467195867136
author Atreja, Nipun
Severtson, Stevan Geoffrey
Jiang, Jenny
Gao, Chuan
Hines, Dionne M.
Cheng, Dong
Hagan, Melissa
Breeze, Janis L.
Paulus, Jessica K.
Secemsky, Eric A.
author_facet Atreja, Nipun
Severtson, Stevan Geoffrey
Jiang, Jenny
Gao, Chuan
Hines, Dionne M.
Cheng, Dong
Hagan, Melissa
Breeze, Janis L.
Paulus, Jessica K.
Secemsky, Eric A.
author_sort Atreja, Nipun
collection PubMed
description Several observational studies have compared apixaban with rivaroxaban in patients with non-valvular atrial fibrillation (NVAF), but these analyses may be confounded by unmeasured characteristics. This study used provider prescribing preference (PPP) as an instrumental variable (IV) to assess the association between prescriber choice of rivaroxaban vs. apixaban and the study outcomes of stroke/systemic embolism (SE), major bleeding, and death in a retrospective cohort of NVAF patients in the US. Initiators of either medication were linked to their prescribers and followed until the first of the study outcome, the end of rivaroxaban/apixaban use, or 365 days after initiation. PPP for each patient was the percent of rivaroxaban initiations issued by the provider for the prior 10 NVAF patients. Cox regression models tested associations between quintiles of PPP and each outcome. A total of 61,155 patients and 1726 providers were included. The IV was a strong predictor of rivaroxaban prescription (OR = 17.9; 95% CI: 16.6, 19.3). There were statistically significant associations between increasing preference for rivaroxaban and rates of major bleeding (ptrend = 0.041) and death (ptrend = 0.031), but not stroke/SE (ptrend = 0.398). This analysis provides evidence of the relative safety of apixaban over rivaroxaban for the risk of major bleeding and death.
format Online
Article
Text
id pubmed-10671855
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-106718552023-11-20 The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data Atreja, Nipun Severtson, Stevan Geoffrey Jiang, Jenny Gao, Chuan Hines, Dionne M. Cheng, Dong Hagan, Melissa Breeze, Janis L. Paulus, Jessica K. Secemsky, Eric A. J Clin Med Article Several observational studies have compared apixaban with rivaroxaban in patients with non-valvular atrial fibrillation (NVAF), but these analyses may be confounded by unmeasured characteristics. This study used provider prescribing preference (PPP) as an instrumental variable (IV) to assess the association between prescriber choice of rivaroxaban vs. apixaban and the study outcomes of stroke/systemic embolism (SE), major bleeding, and death in a retrospective cohort of NVAF patients in the US. Initiators of either medication were linked to their prescribers and followed until the first of the study outcome, the end of rivaroxaban/apixaban use, or 365 days after initiation. PPP for each patient was the percent of rivaroxaban initiations issued by the provider for the prior 10 NVAF patients. Cox regression models tested associations between quintiles of PPP and each outcome. A total of 61,155 patients and 1726 providers were included. The IV was a strong predictor of rivaroxaban prescription (OR = 17.9; 95% CI: 16.6, 19.3). There were statistically significant associations between increasing preference for rivaroxaban and rates of major bleeding (ptrend = 0.041) and death (ptrend = 0.031), but not stroke/SE (ptrend = 0.398). This analysis provides evidence of the relative safety of apixaban over rivaroxaban for the risk of major bleeding and death. MDPI 2023-11-20 /pmc/articles/PMC10671855/ /pubmed/38002802 http://dx.doi.org/10.3390/jcm12227190 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Atreja, Nipun
Severtson, Stevan Geoffrey
Jiang, Jenny
Gao, Chuan
Hines, Dionne M.
Cheng, Dong
Hagan, Melissa
Breeze, Janis L.
Paulus, Jessica K.
Secemsky, Eric A.
The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data
title The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data
title_full The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data
title_fullStr The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data
title_full_unstemmed The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data
title_short The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data
title_sort association between direct oral anticoagulants prescribing behavior and non-valvular atrial fibrillation outcomes: an instrumental variable analysis of real-world data
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10671855/
https://www.ncbi.nlm.nih.gov/pubmed/38002802
http://dx.doi.org/10.3390/jcm12227190
work_keys_str_mv AT atrejanipun theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT severtsonstevangeoffrey theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT jiangjenny theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT gaochuan theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT hinesdionnem theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT chengdong theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT haganmelissa theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT breezejanisl theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT paulusjessicak theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT secemskyerica theassociationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT atrejanipun associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT severtsonstevangeoffrey associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT jiangjenny associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT gaochuan associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT hinesdionnem associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT chengdong associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT haganmelissa associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT breezejanisl associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT paulusjessicak associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata
AT secemskyerica associationbetweendirectoralanticoagulantsprescribingbehaviorandnonvalvularatrialfibrillationoutcomesaninstrumentalvariableanalysisofrealworlddata