Deitelzweig Steven, Baker Christine L, Dhamane Amol D, Mardekian Jack, Dina Oluwaseyi, Rosenblatt Lisa, Russ Cristina, Poretta Tayla, Lingohr-Smith Melissa, Lin Jay
Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.
Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.
J Drug Assess. 2020 Apr 24;9(1):87-96. doi: 10.1080/21556660.2020.1750418. eCollection 2020.
To compare the risks of 1-month all-cause, major bleeding (MB)-related and stroke-related readmissions and the associated hospital resource use and costs among patients previously hospitalized for nonvalvular atrial fibrillation (NVAF) and treated with warfarin, rivaroxaban, and dabigatran vs apixaban. Adult patients hospitalized with NVAF (any discharge diagnosis position) who received apixaban, warfarin, rivaroxaban, or dabigatran during hospitalization were identified from the Premier database (1 January 2013-30 June 2017) and grouped into respective cohorts. Propensity score matching was used to generate cohorts with similar characteristics. In regression analyses the risk of readmissions that occurred within 1 month of discharge were evaluated and the associated length of stay (LOS) and costs compared. NVAF patients treated with warfarin vs apixaban had significantly greater risk of all-cause (odds ratio [OR] = 1.05; confidence interval [CI] = 1.02-1.08; < .001), MB-related (OR: 1.28; CI: 1.16-1.42; < .001), and stroke-related (OR: 1.33; CI: 1.11-1.58; = .002) readmissions; for all readmission categories, average LOS was significantly longer and costs significantly higher for warfarin treated patients. NVAF patients treated with rivaroxaban versus apixaban had significantly greater risk of all-cause (OR: 1.06; CI: 1.02-1.09; = .001) and MB-related (OR = 1.62; CI = 1.44-1.83; < .001) readmissions, but not stroke-related readmission; for MB-related readmissions average LOS and costs were higher for rivaroxaban treated patients. Significant differences in risks of all-cause, MB-related, and stroke-related readmissions were not observed between the apixaban and dabigatran cohorts. In this retrospective real-world analysis of NVAF patients, apixaban treatment was associated with better clinical outcomes than warfarin or rivaroxaban and lower hospital resource burden.
比较曾因非瓣膜性心房颤动（NVAF）住院并接受华法林、利伐沙班、达比加群治疗的患者与接受阿哌沙班治疗的患者1个月内全因再入院、大出血（MB）相关再入院和中风相关再入院的风险，以及相关的医院资源使用和成本。从Premier数据库（2013年1月1日至2017年6月30日）中识别出住院期间接受阿哌沙班、华法林、利伐沙班或达比加群治疗的NVAF住院成年患者（任何出院诊断位置），并将其分组到各自的队列中。采用倾向评分匹配法生成具有相似特征的队列。在回归分析中，评估出院后1个月内发生再入院的风险，并比较相关的住院时间（LOS）和成本。与接受阿哌沙班治疗的NVAF患者相比，接受华法林治疗的患者全因再入院风险显著更高（比值比[OR]=1.05；置信区间[CI]=1.02-1.08；P<0.001）、MB相关再入院风险显著更高（OR：1.28；CI：1.16-1.42；P<0.001）和中风相关再入院风险显著更高（OR：1.33；CI：1.11-1.58；P=0.002）；对于所有再入院类别，接受华法林治疗的患者平均住院时间显著更长，成本显著更高。与接受阿哌沙班治疗的NVAF患者相比，接受利伐沙班治疗的患者全因再入院风险（OR：1.06；CI：1.02-1.09；P=0.001）和MB相关再入院风险显著更高（OR=1.62；CI=1.44-1.83；P<0.001），但中风相关再入院风险无显著差异；对于MB相关再入院，接受利伐沙班治疗的患者平均住院时间和成本更高。在阿哌沙班和达比加群队列之间，未观察到全因、MB相关和中风相关再入院风险的显著差异。在这项对NVAF患者的回顾性真实世界分析中，阿哌沙班治疗与比华法林或利伐沙班更好的临床结局以及更低的医院资源负担相关。
