Journal article
Comparative Effectiveness of Rivaroxaban, Apixaban, and Warfarin in Atrial Fibrillation Patients With Polypharmacy
Stroke (1970), Vol.51(7), pp.2076-2086
07/01/2020
DOI: 10.1161/STROKEAHA.120.029541
PMCID: PMC7388787
PMID: 32517580
Abstract
Background and Purpose: Comparative effectiveness and safety of oral anticoagulants in patients with atrial fibrillation and high polypharmacy are unknown. Methods: We used Medicare administrative data to evaluate patients with new atrial fibrillation diagnosis from 2015 to 2017, who initiated an oral anticoagulant within 90 days of diagnosis. Patients taking <= 3, 4 to 8, or >= 9 other prescription medications were categorized as having low, moderate, or high polypharmacy, respectively. Within polypharmacy categories, patients receiving apixaban 5 mg twice daily, rivaroxaban 20 mg once daily, or warfarin were matched using a 3-way propensity score matching. Study outcomes included ischemic stroke, bleeding, and all-cause mortality. Results: The study cohort included 6985 patients using apixaban, 3838 using rivaroxaban, and 6639 using warfarin. In the propensity-matched cohorts there was no difference in risk of ischemic stroke between the 3 drugs in patients with low and moderate polypharmacy. However, among patients with high polypharmacy, the risk of ischemic stroke was higher with apixaban compared with warfarin (adjusted hazard ratio 2.34 [95% CI, 1.01-5.42];P=0.05) and similar to rivaroxaban (adjusted hazard ratio, 1.38 [95% CI, 0.67-2.84];P=0.4). There was no difference in risk of death between the 3 drugs in patients with low and moderate polypharmacy, but apixaban was associated with a higher risk of death compared with rivaroxaban (adjusted hazard ratio, 2.03 [95% CI, 1.01-4.08];P=0.05) in the high polypharmacy group. Apixaban had lower bleeding risk compared with warfarin in the low polypharmacy group (adjusted hazard ratio, 0.54 [95% CI, 0.32-0.90];P=0.02), but there was no difference in bleeding between the 3 drugs in the moderate and high polypharmacy groups. Conclusions: Our study suggests that among patients with significant polypharmacy (>8 drugs), there may be a higher stroke and mortality risk with apixaban compared with warfarin and rivaroxaban. However, differences were of borderline significance.
Details
- Title: Subtitle
- Comparative Effectiveness of Rivaroxaban, Apixaban, and Warfarin in Atrial Fibrillation Patients With Polypharmacy
- Creators
- Amgad Mentias - University of IowaEric Heller - University of IowaMary Vaughan Sarrazin - Univ Iowa, Dept Internal Med, 200 Hawkins Dr,C44-GH, Iowa City, IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.51(7), pp.2076-2086
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1161/STROKEAHA.120.029541
- PMID
- 32517580
- PMCID
- PMC7388787
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Number of pages
- 11
- Grant note
- R01 AG055663 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) T32 HL007121 / National Institutes of Health National Research Service Award institutional grant at the Abboud Cardiovascular Research Center; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Health Services Research and Development Service of the Department of Veterans Affairs; US Department of Veterans Affairs
- Language
- English
- Date published
- 07/01/2020
- Academic Unit
- Health Management and Policy; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359805102771
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