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Apixaban vs. Warfarin in Atrial Fibrillation Patients With Chronic Kidney Disease

Background and Objectives: Real-world evidence of apixaban treatment in patients with chronic kidney disease remains scarce. This study aimed to compare the relative risk of stroke or systemic embolism (SE) and major bleeding between apixaban and warfarin in atrial fibrillation (AF) patients with di...

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Autores principales: Fu, Chung-Ming, Li, Lung-Chih, Lee, Yueh-Ting, Wang, Shih-Wei, Hsu, Chien-Ning
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558356/
https://www.ncbi.nlm.nih.gov/pubmed/34733897
http://dx.doi.org/10.3389/fcvm.2021.752468
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author Fu, Chung-Ming
Li, Lung-Chih
Lee, Yueh-Ting
Wang, Shih-Wei
Hsu, Chien-Ning
author_facet Fu, Chung-Ming
Li, Lung-Chih
Lee, Yueh-Ting
Wang, Shih-Wei
Hsu, Chien-Ning
author_sort Fu, Chung-Ming
collection PubMed
description Background and Objectives: Real-world evidence of apixaban treatment in patients with chronic kidney disease remains scarce. This study aimed to compare the relative risk of stroke or systemic embolism (SE) and major bleeding between apixaban and warfarin in atrial fibrillation (AF) patients with different degrees of kidney function. Design, Setting, Participants, and Measurements: We evaluated newly diagnosed AF patients between 2004 and 2018, who were receiving apixaban or warfarin. Electronic medical record data were collected from a large healthcare delivery network in Taiwan. The outcomes of hospitalization for stroke/SE and major bleeding were compared with propensity-score matched apixaban and warfarin cohorts. Stratified analyses according to initial apixaban dose (standard dose of 10 mg/day vs. lower dose of 2.5–5.0 mg/day) and baseline estimated glomerular filtration rate were performed. Results: Each cohort involved 1,625 matched patients. Apixaban was significantly associated with a lower risk of stroke/SE (adjusted hazard ratio [aHR]: 0.74; 95% confidence interval [CI]:0.57–0.97; p = 0.03). The risk of major bleeding was not increased whether in standard doses (aHR: 0.66; 95% CI: 0.45–0.96; p = 0.03) or reduced doses (aHR, 0.84; 95% CI, 0.63–1.12; p = 0.23) of apixaban. Regarding kidney function, apixaban reduced the risk of stroke/SE by 37% in those with an eGFR of <30 ml/min/1.73 m(2) (aHR: 0.63; 95% CI: 0.40–0.98; p = 0.04). Conclusions: Compared to warfarin, apixaban is associated with a reduced risk of stroke/SE and is consistent with a subset of AF patients with eGFR <30 ml/min/1.73 m(2). Both standard and reduced doses of apixaban showed lower risk of major bleeding than those of warfarin.
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spelling pubmed-85583562021-11-02 Apixaban vs. Warfarin in Atrial Fibrillation Patients With Chronic Kidney Disease Fu, Chung-Ming Li, Lung-Chih Lee, Yueh-Ting Wang, Shih-Wei Hsu, Chien-Ning Front Cardiovasc Med Cardiovascular Medicine Background and Objectives: Real-world evidence of apixaban treatment in patients with chronic kidney disease remains scarce. This study aimed to compare the relative risk of stroke or systemic embolism (SE) and major bleeding between apixaban and warfarin in atrial fibrillation (AF) patients with different degrees of kidney function. Design, Setting, Participants, and Measurements: We evaluated newly diagnosed AF patients between 2004 and 2018, who were receiving apixaban or warfarin. Electronic medical record data were collected from a large healthcare delivery network in Taiwan. The outcomes of hospitalization for stroke/SE and major bleeding were compared with propensity-score matched apixaban and warfarin cohorts. Stratified analyses according to initial apixaban dose (standard dose of 10 mg/day vs. lower dose of 2.5–5.0 mg/day) and baseline estimated glomerular filtration rate were performed. Results: Each cohort involved 1,625 matched patients. Apixaban was significantly associated with a lower risk of stroke/SE (adjusted hazard ratio [aHR]: 0.74; 95% confidence interval [CI]:0.57–0.97; p = 0.03). The risk of major bleeding was not increased whether in standard doses (aHR: 0.66; 95% CI: 0.45–0.96; p = 0.03) or reduced doses (aHR, 0.84; 95% CI, 0.63–1.12; p = 0.23) of apixaban. Regarding kidney function, apixaban reduced the risk of stroke/SE by 37% in those with an eGFR of <30 ml/min/1.73 m(2) (aHR: 0.63; 95% CI: 0.40–0.98; p = 0.04). Conclusions: Compared to warfarin, apixaban is associated with a reduced risk of stroke/SE and is consistent with a subset of AF patients with eGFR <30 ml/min/1.73 m(2). Both standard and reduced doses of apixaban showed lower risk of major bleeding than those of warfarin. Frontiers Media S.A. 2021-10-18 /pmc/articles/PMC8558356/ /pubmed/34733897 http://dx.doi.org/10.3389/fcvm.2021.752468 Text en Copyright © 2021 Fu, Li, Lee, Wang and Hsu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Fu, Chung-Ming
Li, Lung-Chih
Lee, Yueh-Ting
Wang, Shih-Wei
Hsu, Chien-Ning
Apixaban vs. Warfarin in Atrial Fibrillation Patients With Chronic Kidney Disease
title Apixaban vs. Warfarin in Atrial Fibrillation Patients With Chronic Kidney Disease
title_full Apixaban vs. Warfarin in Atrial Fibrillation Patients With Chronic Kidney Disease
title_fullStr Apixaban vs. Warfarin in Atrial Fibrillation Patients With Chronic Kidney Disease
title_full_unstemmed Apixaban vs. Warfarin in Atrial Fibrillation Patients With Chronic Kidney Disease
title_short Apixaban vs. Warfarin in Atrial Fibrillation Patients With Chronic Kidney Disease
title_sort apixaban vs. warfarin in atrial fibrillation patients with chronic kidney disease
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558356/
https://www.ncbi.nlm.nih.gov/pubmed/34733897
http://dx.doi.org/10.3389/fcvm.2021.752468
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