Abstract
Abstract 13643: Effectiveness and Safety of Rivaroxaban versus Warfarin in Patients With Non-Valvular Atrial Fibrillation (NVAF) and Stage IV-V Chronic Kidney Disease (CKD) as Determined by Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) Equations
Circulation (New York, N.Y.), Vol.140(Suppl_1 Suppl 1), pp.A13643-A13643
11/19/2019
DOI: 10.1161/circ.140.suppl_1.13643
Abstract
BackgroundThere is limited evidence on the effectiveness and safety of rivaroxaban in NVAF patients with advanced CKD. We compared risk of ischemic stroke/systemic embolism (ISSE) and major bleeding in rivaroxaban and warfarin treated NVAF patients with advanced CKD.MethodsUsing data from Optum Deidentified Electronic Health Record Database, we selected patients with NVAF and stage IV-V CKD who initiated rivaroxaban or warfarin therapy from November 2011 - June 2018. CKD status was determined from diagnosis codes with confirmation via receipt of dialysis or labs using CG (primary analysis) or MDRD (secondary analysis). Propensity score (PS) matching was used to balance the rivaroxaban and warfarin cohorts on baseline covariates. ISSE and major bleeding hospitalizations over 2 years following treatment initiation were ascertained with validated endpoint definitions.ResultsA total of 781 rivaroxaban patients were PS-matched to 1,536 warfarin patients in the primary analysis; 943 and 1,870 patients were matched in the secondary analysis, respectively. For both analyses, after PS matching, baseline covariates were well balanced across the treatment cohorts. Patients identified in the primary analysis were slightly older and more likely to be female than the secondary analysis. CKD severity, Charlson Comorbidity Index, CHA2DS2-VASc and HAS-BLED scores were similar in the two analyses. The relative hazard (HR) of ISSE associated with rivaroxaban use compared to warfarin use was 0.93 (95% CI0.46, 1.90), and HR for major bleeding was 0.91 (95% CI0.65, 1.28) in the primary analysis. Results were similar when MDRD was used rather than CG to characterize CKD severity (HR=1.16 95% CI0.52, 2.60 for ISSE; HR=1.14, 95% CI0.83, 1.57 for bleeding; see Table).ConclusionsRegardless of the method used to determine advanced CKD, no statistically significant differences in ISSE or major bleeding risk were found between patients treated with rivaroxaban or warfarin.
Details
- Title: Subtitle
- Abstract 13643: Effectiveness and Safety of Rivaroxaban versus Warfarin in Patients With Non-Valvular Atrial Fibrillation (NVAF) and Stage IV-V Chronic Kidney Disease (CKD) as Determined by Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) Equations
- Creators
- Matthew Weir - -, Univ of Maryland Sch of Medicine, Baltimore, MDVeronica AshtonEric AmmannKenneth Moore - -, Janssen Med Affairs, Titusville, NJShubham ShrivastavaEric Peterson - Duke University
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.140(Suppl_1 Suppl 1), pp.A13643-A13643
- Publisher
- by the American College of Cardiology Foundation and the American Heart Association, Inc
- DOI
- 10.1161/circ.140.suppl_1.13643
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 11/19/2019
- Academic Unit
- Epidemiology; Epidemiology
- Record Identifier
- 9984363561602771
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