Natale Andrea, Mohanty Sanghamitra, Chen Cindy, Zhao Yuan, Campbell Alicia K, Bookhart Brahim, Ashton Veronica
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA.
J Interv Card Electrophysiol. 2025 Apr;68(3):613-624. doi: 10.1007/s10840-024-01940-6. Epub 2024 Nov 25.
Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are often comorbid and associated with increased risk of cardiovascular events such as stroke. We evaluated the effectiveness, safety, healthcare resource utilization, and costs of rivaroxaban versus warfarin in patients with nonvalvular AF (NVAF) and comorbid OSA.
We used the IQVIA PharMetrics Plus adjudicated claims database to evaluate patients with NVAF, OSA, and moderate-to-severe stroke risk who initiated rivaroxaban or warfarin between November 2011 and December 2022. We adjusted for potential confounders with propensity score overlap weighting. Primary endpoints were evaluated based on intent-to-treat (ITT) and on-treatment follow-up to compare stroke or systemic embolism risk, major bleeding risk, all-cause healthcare resource utilization (inpatient hospitalizations, emergency department visits, outpatient visits, and pharmacy fills), and costs (per patient per year [PPPY]) by treatment cohort.
In total, 14,765 patients were included (9133 received rivaroxaban; 5632 received warfarin). Rivaroxaban significantly reduced stroke or systemic embolism versus warfarin by 26% (ITT-hazard ratio, 0.74 [95% CI 0.60-0.91]; P = 0.004) and 30% (on-treatment-hazard ratio, 0.70 [95% CI 0.55-0.89]; P = 0.004). Major bleeding was not significantly different between rivaroxaban and warfarin in either analysis. All-cause healthcare resource utilization was significantly reduced with rivaroxaban versus warfarin, leading to significantly reduced PPPY costs.
Among patients with NVAF and OSA, rivaroxaban was associated with a significant reduction in stroke or systemic embolism risk versus warfarin with no difference in major bleeding. Rivaroxaban significantly reduced healthcare resource utilization and costs compared with warfarin, providing support for the use of rivaroxaban in this population.
心房颤动（AF）与阻塞性睡眠呼吸暂停（OSA）常合并存在，且与中风等心血管事件风险增加相关。我们评估了利伐沙班与华法林在非瓣膜性心房颤动（NVAF）合并OSA患者中的有效性、安全性、医疗资源利用情况及成本。
我们使用IQVIA PharMetrics Plus判定性索赔数据库，评估2011年11月至2022年12月期间开始使用利伐沙班或华法林的NVAF、OSA及中重度中风风险患者。我们采用倾向得分重叠加权法对潜在混杂因素进行校正。主要终点基于意向性治疗（ITT）和治疗期随访进行评估，以比较治疗组之间的中风或全身性栓塞风险、大出血风险、全因医疗资源利用情况（住院、急诊就诊、门诊就诊及药房配药）以及成本（每年每位患者[PPPY]）。
总共纳入14765例患者（9133例接受利伐沙班治疗；5632例接受华法林治疗）。与华法林相比，利伐沙班使中风或全身性栓塞风险显著降低26%（ITT风险比，0.74[95%CI 0.60 - 0.91]；P = 0.004），治疗期风险比降低30%（0.70[95%CI 0.55 - 0.89]；P = 0.004）。在两项分析中，利伐沙班与华法林之间的大出血情况均无显著差异。与华法林相比，利伐沙班显著降低了全因医疗资源利用情况，导致PPPY成本显著降低。
在NVAF合并OSA患者中，与华法林相比，利伐沙班使中风或全身性栓塞风险显著降低，大出血情况无差异。与华法林相比，利伐沙班显著降低了医疗资源利用情况及成本，为该人群使用利伐沙班提供了支持。
