Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building 6 West Derby Street, L7 8TX, Liverpool, United Kingdom.
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
J Thromb Thrombolysis. 2022 Jul;54(1):33-46. doi: 10.1007/s11239-022-02660-2. Epub 2022 May 17.
There are a paucity of real-world data examining effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in nonvalvular atrial fibrillation (NVAF) patients with prior bleeding.
This retrospective analysis included data from 5 insurance claims databases and included NVAF patients prescribed OACs with prior bleeding. One-to-one propensity score matching was conducted between NOACs and warfarin and between NOACs in each database. Cox proportional hazards models were used to evaluate the risk of stroke/systemic embolism (SE) and MB.
A total of 244,563 patients (mean age 77; 50% female) with prior bleeding included 55,094 (22.5%) treated with apixaban, 12,500 (5.1%) with dabigatran, 38,246 (15.6%) with rivaroxaban, and 138,723 (56.7%) with warfarin. Apixaban (hazard ratio [HR]: 0.76 [95% CI: 0.70, 0.83]) and rivaroxaban (HR: 0.79 [95% CI: 0.71, 0.87]) had a lower risk of stroke/SE vs. warfarin. Apixaban (HR: 0.67 [95% CI: 0.64, 0.70]) and dabigatran (HR: 0.88 [95% CI: 0.81, 0.96]) had a lower risk of MB vs. warfarin. Apixaban patients had a lower risk of stroke/SE vs. dabigatran (HR: 0.70 [95% CI: 0.57, 0.86]) and rivaroxaban (HR: 0.85 [95% CI: 0.76, 0.96]) and a lower risk of MB than dabigatran (HR: 0.73 [95% CI: 0.67, 0.81]) and rivaroxaban (HR: 0.64 [95% CI: 0.61, 0.68]).
In this real-world analysis of a large sample of NVAF patients with prior bleeding, NOACs were associated with similar or lower risk of stroke/SE and MB vs. warfarin and variable risk of stroke/SE and MB against each other.
在有既往出血史的非瓣膜性心房颤动（NVAF）患者中，很少有真实世界的数据研究非维生素 K 拮抗剂口服抗凝剂（NOACs）和华法林的有效性和安全性。
本回顾性分析纳入了来自 5 个保险索赔数据库的数据，包括有既往出血史且接受 OAC 治疗的 NVAF 患者。NOACs 与华法林以及每个数据库中的 NOACs 之间进行了一对一倾向评分匹配。采用 Cox 比例风险模型评估卒中/全身性栓塞（SE）和大出血（MB）的风险。
共纳入 244563 例有既往出血史的患者（平均年龄 77 岁，50%为女性），其中 55094 例（22.5%）接受阿哌沙班治疗，12500 例（5.1%）接受达比加群治疗，38246 例（15.6%）接受利伐沙班治疗，138723 例（56.7%）接受华法林治疗。与华法林相比，阿哌沙班（风险比 [HR]：0.76 [95% CI：0.70, 0.83]）和利伐沙班（HR：0.79 [95% CI：0.71, 0.87]）的卒中/SE 风险更低。与华法林相比，阿哌沙班（HR：0.67 [95% CI：0.64, 0.70]）和达比加群（HR：0.88 [95% CI：0.81, 0.96]）的 MB 风险更低。与达比加群（HR：0.70 [95% CI：0.57, 0.86]）和利伐沙班（HR：0.85 [95% CI：0.76, 0.96]）相比，阿哌沙班患者的卒中/SE 风险更低，与达比加群（HR：0.73 [95% CI：0.67, 0.81]）和利伐沙班（HR：0.64 [95% CI：0.61, 0.68]）相比，阿哌沙班患者的 MB 风险更低。
在这项对有既往出血史的 NVAF 患者进行的大型样本真实世界分析中，与华法林相比，NOACs 与卒中/SE 和 MB 的风险相似或更低，而与其他药物相比，NOACs 的卒中/SE 和 MB 风险存在差异。
