Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA.
Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
J Am Heart Assoc. 2017 Aug 18;6(8):e006381. doi: 10.1161/JAHA.117.006381.
Sex-specific effectiveness of rivaroxaban (RIVA), dabigatran (DABI), and warfarin in reducing myocardial infarction (MI), heart failure (HF), and all-cause mortality among patients with atrial fibrillation are not known. We assessed sex-specific associations of RIVA, DABI, or warfarin use with the risk of MI, HF, and all-cause mortality among patients with atrial fibrillation.
Medicare beneficiaries (men: 65 734 [44.8%], women: 81 135 [55.2%]) with atrial fibrillation who initiated oral anticoagulants formed the study cohort. Inpatient admissions for MI, HF, and all-cause mortality were compared between the 3 drugs separately for men and women using 3-way propensity-matched samples. In men, RIVA use was associated with a reduced risk of MI admissions compared with warfarin use (hazard ratio [95% confidence interval (CI): 0.59 [0.38-0.91]), with a trend towards reduced risk compared with DABI use (0.67 [0.44-1.01]). In women, there were no significant differences in the risk of MI admissions across all 3 anticoagulants. In both sexes, RIVA use and DABI use were associated with reduced risk of HF admissions (men: RIVA; 0.75 [0.63-0.89], DABI; 0.81 [0.69-0.96]) (women: RIVA; 0.64 [0.56-0.74], DABI; 0.73 [0.63-0.83]) and all-cause mortality (men: RIVA; 0.66 [0.53-0.81], DABI; 0.75 [0.61-0.93]) (women: RIVA; 0.76 [0.63-0.91], DABI; 0.77 [0.64-0.93]) compared with warfarin use.
RIVA use and DABI use when compared with warfarin use was associated with a reduced risk of HF admissions and all-cause mortality in both sexes. However, reduced risk of MI admissions noted with RIVA use appears to be limited to men.
目前尚不清楚利伐沙班（RIVA）、达比加群（DABI）和华法林在降低房颤患者心肌梗死（MI）、心力衰竭（HF）和全因死亡率方面的性别特异性疗效。我们评估了 RIVA、DABI 或华法林的使用与房颤患者的 MI、HF 和全因死亡率风险之间的性别特异性关联。
这项研究纳入了使用口服抗凝剂的 Medicare 受益人群（男性：65734 例[44.8%]，女性：81135 例[55.2%]）。分别在男性和女性中，使用三向倾向匹配样本，比较了 3 种药物在住院治疗 MI、HF 和全因死亡率方面的差异。与华法林相比，男性使用 RIVA 可降低 MI 住院风险（风险比[95%置信区间（CI）]：0.59 [0.38-0.91]），与 DABI 相比，也有降低风险的趋势（0.67 [0.44-1.01]）。在女性中，3 种抗凝药物的 MI 住院风险无显著差异。在两性中，RIVA 和 DABI 的使用与 HF 住院风险降低相关（男性：RIVA，0.75 [0.63-0.89]，DABI，0.81 [0.69-0.96]）（女性：RIVA，0.64 [0.56-0.74]，DABI，0.73 [0.63-0.83]）和全因死亡率（男性：RIVA，0.66 [0.53-0.81]，DABI，0.75 [0.61-0.93]）（女性：RIVA，0.76 [0.63-0.91]，DABI，0.77 [0.64-0.93]）相比，华法林的使用。
与华法林相比，RIVA 和 DABI 的使用与两性 HF 住院和全因死亡率降低相关。然而，RIVA 降低 MI 住院风险的效果似乎仅限于男性。
