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Warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: A national retrospective study

BACKGROUND: No real‐world data exist on outcomes in patients on anticoagulants and concomitant antiarrhythmic medications. This study aims to compare the safety and effectiveness of apixaban and warfarin, first in patients with nonvalvular atrial fibrillation (NVAF) and then in patients on concurren...

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Autores principales: Wanat, Matthew A., Wang, Xin, Paranjpe, Rutugandha, Chen, Hua, Johnson, Michael L., Fleming, Marc L., Abughosh, Susan M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6781914/
https://www.ncbi.nlm.nih.gov/pubmed/31624787
http://dx.doi.org/10.1002/rth2.12221
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author Wanat, Matthew A.
Wang, Xin
Paranjpe, Rutugandha
Chen, Hua
Johnson, Michael L.
Fleming, Marc L.
Abughosh, Susan M.
author_facet Wanat, Matthew A.
Wang, Xin
Paranjpe, Rutugandha
Chen, Hua
Johnson, Michael L.
Fleming, Marc L.
Abughosh, Susan M.
author_sort Wanat, Matthew A.
collection PubMed
description BACKGROUND: No real‐world data exist on outcomes in patients on anticoagulants and concomitant antiarrhythmic medications. This study aims to compare the safety and effectiveness of apixaban and warfarin, first in patients with nonvalvular atrial fibrillation (NVAF) and then in patients on concurrent antiarrhythmic medications. METHODS: A retrospective cohort study was conducted using a large US electronic medical record database (2012‐2016). Patients with NVAF on warfarin or apixaban were included. The primary endpoint was a composite of stroke (ischemic or hemorrhagic) or systemic embolism. The primary safety endpoint was major bleeding (ISTH definition). Patients were matched using propensity scoring. Univariate survival analyses were conducted by using the log‐rank test and Kaplan‐Meier survival curves. A subgroup analysis was conducted to assess outcomes on patients on concurrent antiarrhythmic medications. RESULTS: A total of 332 100 patients with NVAF were identified, and 20 378 were included in the propensity‐matching analysis. No baseline differences were seen in age, comorbidities, or CHA (2) DS (2)‐VASc score. The primary endpoint occurred in 122 (1.2%) patients on apixaban compared to 166 (1.63%) on warfarin (hazard ratio, 0.84; 95% confidence interval [CI], 0.79‐0.88). Major bleeding occurred at a lower rate in the apixaban group (n = 600, 5.89%) compared to warfarin (n = 887, 8.71%) (odds ratio, 0.65; 95% CI, 0.58‐0.73). In patients on concurrent antiarrhythmic medications (n = 2498), there was no difference in thrombotic (1.04% vs. 1.37%; P = 0.42) or bleeding events (5.29% vs. 6.89%; P = 0.08). CONCLUSION: Apixaban was associated with reduced stroke/systemic embolism and bleeding when compared with warfarin. No difference was seen in thrombotic or bleeding events in patients on concurrent antiarrhythmic medications.
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spelling pubmed-67819142019-10-17 Warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: A national retrospective study Wanat, Matthew A. Wang, Xin Paranjpe, Rutugandha Chen, Hua Johnson, Michael L. Fleming, Marc L. Abughosh, Susan M. Res Pract Thromb Haemost Original Articles: Thrombosis BACKGROUND: No real‐world data exist on outcomes in patients on anticoagulants and concomitant antiarrhythmic medications. This study aims to compare the safety and effectiveness of apixaban and warfarin, first in patients with nonvalvular atrial fibrillation (NVAF) and then in patients on concurrent antiarrhythmic medications. METHODS: A retrospective cohort study was conducted using a large US electronic medical record database (2012‐2016). Patients with NVAF on warfarin or apixaban were included. The primary endpoint was a composite of stroke (ischemic or hemorrhagic) or systemic embolism. The primary safety endpoint was major bleeding (ISTH definition). Patients were matched using propensity scoring. Univariate survival analyses were conducted by using the log‐rank test and Kaplan‐Meier survival curves. A subgroup analysis was conducted to assess outcomes on patients on concurrent antiarrhythmic medications. RESULTS: A total of 332 100 patients with NVAF were identified, and 20 378 were included in the propensity‐matching analysis. No baseline differences were seen in age, comorbidities, or CHA (2) DS (2)‐VASc score. The primary endpoint occurred in 122 (1.2%) patients on apixaban compared to 166 (1.63%) on warfarin (hazard ratio, 0.84; 95% confidence interval [CI], 0.79‐0.88). Major bleeding occurred at a lower rate in the apixaban group (n = 600, 5.89%) compared to warfarin (n = 887, 8.71%) (odds ratio, 0.65; 95% CI, 0.58‐0.73). In patients on concurrent antiarrhythmic medications (n = 2498), there was no difference in thrombotic (1.04% vs. 1.37%; P = 0.42) or bleeding events (5.29% vs. 6.89%; P = 0.08). CONCLUSION: Apixaban was associated with reduced stroke/systemic embolism and bleeding when compared with warfarin. No difference was seen in thrombotic or bleeding events in patients on concurrent antiarrhythmic medications. John Wiley and Sons Inc. 2019-06-17 /pmc/articles/PMC6781914/ /pubmed/31624787 http://dx.doi.org/10.1002/rth2.12221 Text en © 2019 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles: Thrombosis
Wanat, Matthew A.
Wang, Xin
Paranjpe, Rutugandha
Chen, Hua
Johnson, Michael L.
Fleming, Marc L.
Abughosh, Susan M.
Warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: A national retrospective study
title Warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: A national retrospective study
title_full Warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: A national retrospective study
title_fullStr Warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: A national retrospective study
title_full_unstemmed Warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: A national retrospective study
title_short Warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: A national retrospective study
title_sort warfarin vs. apixaban in nonvalvular atrial fibrillation, and analysis by concomitant antiarrhythmic medication use: a national retrospective study
topic Original Articles: Thrombosis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6781914/
https://www.ncbi.nlm.nih.gov/pubmed/31624787
http://dx.doi.org/10.1002/rth2.12221
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