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Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity
INTRODUCTION: Non-valvular atrial fibrillation (NVAF) is often accompanied by multiple comorbid conditions, which increase the associated risks and complexity of patient management. This study evaluated the risk of stroke/systemic embolism (SE) and major bleeding (MB) among multimorbid patients with...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Healthcare
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190022/ https://www.ncbi.nlm.nih.gov/pubmed/33963511 http://dx.doi.org/10.1007/s12325-021-01724-8 |
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author | Deitelzweig, Steven Keshishian, Allison Kang, Amiee Dhamane, Amol D. Luo, Xuemei Klem, Christian Rosenblatt, Lisa Mardekian, Jack Jiang, Jenny Yuce, Huseyin Lip, Gregory Y. H. |
author_facet | Deitelzweig, Steven Keshishian, Allison Kang, Amiee Dhamane, Amol D. Luo, Xuemei Klem, Christian Rosenblatt, Lisa Mardekian, Jack Jiang, Jenny Yuce, Huseyin Lip, Gregory Y. H. |
author_sort | Deitelzweig, Steven |
collection | PubMed |
description | INTRODUCTION: Non-valvular atrial fibrillation (NVAF) is often accompanied by multiple comorbid conditions, which increase the associated risks and complexity of patient management. This study evaluated the risk of stroke/systemic embolism (SE) and major bleeding (MB) among multimorbid patients with NVAF who were prescribed non-vitamin K antagonist oral anticoagulants (NOACs) or warfarin. METHODS: A retrospective study of patients with NVAF and high multimorbidity who initiated apixaban, dabigatran, rivaroxaban, or warfarin from 1 January 2013 to 30 September 2015 was conducted using five insurance claims databases. Multimorbidity was defined as six or more comorbid conditions, and 1:1 propensity score matching (PSM) was conducted between the NOAC-warfarin and NOAC-NOAC cohorts. Cox proportional hazard models were used to evaluate the hazard ratios of stroke/SE and MB. RESULTS: Of the NVAF population (n = 466,991), 33.4% (n = 155,959) had multimorbidity, including 36,921 apixaban, 10,248 dabigatran, 45,509 rivaroxaban, and 63,281 warfarin patients. Compared to warfarin, apixaban and rivaroxaban were associated with a lower risk of stroke/SE (hazard ratio [HR] 0.63, 95% CI 0.54–0.74; HR 0.70, 95% CI 0.64–0.77, respectively). Apixaban and dabigatran were associated with a lower risk of MB (HR 0.61, 95% CI 0.56–0.67; HR 0.75, 95% CI 0.66–0.86, respectively) and rivaroxaban was associated with a higher risk of MB (HR 1.06, 95% CI 1.01–1.12) compared to warfarin. CONCLUSIONS: Among patients with NVAF and six or more comorbid conditions, NOACs were associated with varying risk of stroke/SE and MB compared to warfarin and to each other. Rather than a “one drug fits all” approach, our results may be useful for appropriate OAC treatment for multimorbid patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12325-021-01724-8. |
format | Online Article Text |
id | pubmed-8190022 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Healthcare |
record_format | MEDLINE/PubMed |
spelling | pubmed-81900222021-06-28 Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity Deitelzweig, Steven Keshishian, Allison Kang, Amiee Dhamane, Amol D. Luo, Xuemei Klem, Christian Rosenblatt, Lisa Mardekian, Jack Jiang, Jenny Yuce, Huseyin Lip, Gregory Y. H. Adv Ther Original Research INTRODUCTION: Non-valvular atrial fibrillation (NVAF) is often accompanied by multiple comorbid conditions, which increase the associated risks and complexity of patient management. This study evaluated the risk of stroke/systemic embolism (SE) and major bleeding (MB) among multimorbid patients with NVAF who were prescribed non-vitamin K antagonist oral anticoagulants (NOACs) or warfarin. METHODS: A retrospective study of patients with NVAF and high multimorbidity who initiated apixaban, dabigatran, rivaroxaban, or warfarin from 1 January 2013 to 30 September 2015 was conducted using five insurance claims databases. Multimorbidity was defined as six or more comorbid conditions, and 1:1 propensity score matching (PSM) was conducted between the NOAC-warfarin and NOAC-NOAC cohorts. Cox proportional hazard models were used to evaluate the hazard ratios of stroke/SE and MB. RESULTS: Of the NVAF population (n = 466,991), 33.4% (n = 155,959) had multimorbidity, including 36,921 apixaban, 10,248 dabigatran, 45,509 rivaroxaban, and 63,281 warfarin patients. Compared to warfarin, apixaban and rivaroxaban were associated with a lower risk of stroke/SE (hazard ratio [HR] 0.63, 95% CI 0.54–0.74; HR 0.70, 95% CI 0.64–0.77, respectively). Apixaban and dabigatran were associated with a lower risk of MB (HR 0.61, 95% CI 0.56–0.67; HR 0.75, 95% CI 0.66–0.86, respectively) and rivaroxaban was associated with a higher risk of MB (HR 1.06, 95% CI 1.01–1.12) compared to warfarin. CONCLUSIONS: Among patients with NVAF and six or more comorbid conditions, NOACs were associated with varying risk of stroke/SE and MB compared to warfarin and to each other. Rather than a “one drug fits all” approach, our results may be useful for appropriate OAC treatment for multimorbid patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12325-021-01724-8. Springer Healthcare 2021-05-07 2021 /pmc/articles/PMC8190022/ /pubmed/33963511 http://dx.doi.org/10.1007/s12325-021-01724-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis 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 Deitelzweig, Steven Keshishian, Allison Kang, Amiee Dhamane, Amol D. Luo, Xuemei Klem, Christian Rosenblatt, Lisa Mardekian, Jack Jiang, Jenny Yuce, Huseyin Lip, Gregory Y. H. Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity |
title | Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity |
title_full | Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity |
title_fullStr | Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity |
title_full_unstemmed | Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity |
title_short | Use of Non-Vitamin K Antagonist Oral Anticoagulants Among Patients with Nonvalvular Atrial Fibrillation and Multimorbidity |
title_sort | use of non-vitamin k antagonist oral anticoagulants among patients with nonvalvular atrial fibrillation and multimorbidity |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190022/ https://www.ncbi.nlm.nih.gov/pubmed/33963511 http://dx.doi.org/10.1007/s12325-021-01724-8 |
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