Gregory Y H Lip1,2, Allison Keshishian3,4, Amiee Kang5, Amol D Dhamane5, Xuemei Luo6, Christian Klem7, Lisa Rosenblatt8, Jack Mardekian9, Jenny Jiang10, Huseyin Yuce4, Steven Deitelzweig11,12. 1. University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool Centre for Cardiovascular Science, Liverpool L69 3BX, UK. 2. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 7K, 9220 Aalborg Øst, Denmark. 3. STATinMED Research, Health Economics and Outcomes Research, 4110 Varsity Drive, Ann Arbor, MI 48108, USA. 4. City University of New York, New York City College of Technology, 425 E 25th St, New York, NY 10010, USA. 5. Bristol-Myers Squibb Company, Worldwide Health Economics and Outcomes, Lawrenceville, NJ, USA. 6. Pfizer, Inc., Global Research and Development, 280 Shennecossett Rd, Groton, CT 06340, USA. 7. Bristol-Myers Squibb Company, Worldwide Medical Affairs, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA. 8. Bristol-Myers Squibb Company, US Medical, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA. 9. Pfizer, Inc., Statistics, 235 E 42nd St, New York, NY 10017, USA. 10. Bristol-Myers Squibb Company, CORDS Business Insights and Analytics, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA. 11. Ochsner Clinic Foundation, Department of Hospital Medicine, 1514 Jefferson Hwy, 70121, New Orleans, LA, USA. 12. The University of Queensland School of Medicine, Ochsner Clinical School, 1514 Jefferson Hwy, 70121, New Orleans, LA, USA.
Abstract
AIMS: Polypharmacy is prevalent among non-valvular atrial fibrillation (NVAF) patients and presents a potential issue for the effective management of NVAF. This study compared the risk of stroke/systemic embolism (SE) and major bleeding (MB) among NVAF patients with polypharmacy newly prescribed oral anticoagulants (OACs). METHODS AND RESULTS: A retrospective study of NVAF patients with polypharmacy who initiated OACs from 01 January 2013 to 30 September 2015 was conducted using US CMS Medicare and four commercial databases. Polypharmacy was defined as ≥6 concomitant medications on the index date. Propensity score matching was conducted to compare non-vitamin K antagonists OACs (NOACs) to warfarin as well as between NOACs. Cox proportional hazard models were used to evaluate the risk of stroke/SE and MB. A total of 188 893 patients with polypharmacy were included, with an average of 8 concomitant medications (interquartile range 6-9). Compared to warfarin, apixaban [hazard ratio (HR): 0.59, 95% confidence interval (CI): 0.52-0.68], and rivaroxaban (HR: 0.75, 95% CI: 0.69-0.83) were associated with a lower risk of stroke/SE. Apixaban (HR: 0.57, 95% CI: 0.54-0.61) and dabigatran (HR: 0.76, 95% CI: 0.66-0.88) were associated with a decreased risk of MB compared with warfarin. Compared with dabigatran and rivaroxaban, apixaban was associated with a lower risk of stroke/SE and MB. Dabigatran was associated with lower risk of MB compared with rivaroxaban. CONCLUSIONS: In this observational study of anticoagulated NVAF patients with polypharmacy, effectiveness and safety profiles are more favourable for NOACs vs. warfarin. Our observations are hypothesis generating and may help inform future clinical trials regarding appropriate OAC treatment selection in polypharmacy patients. Published on behalf of the European Society of Cardiology.
AIMS: Polypharmacy is prevalent among non-valvular atrial fibrillation (NVAF) patients and presents a potential issue for the effective management of NVAF. This study compared the risk of stroke/systemic embolism (SE) and major bleeding (MB) among NVAF patients with polypharmacy newly prescribed oral anticoagulants (OACs). METHODS AND RESULTS: A retrospective study of NVAF patients with polypharmacy who initiated OACs from 01 January 2013 to 30 September 2015 was conducted using US CMS Medicare and four commercial databases. Polypharmacy was defined as ≥6 concomitant medications on the index date. Propensity score matching was conducted to compare non-vitamin K antagonists OACs (NOACs) to warfarin as well as between NOACs. Cox proportional hazard models were used to evaluate the risk of stroke/SE and MB. A total of 188 893 patients with polypharmacy were included, with an average of 8 concomitant medications (interquartile range 6-9). Compared to warfarin, apixaban [hazard ratio (HR): 0.59, 95% confidence interval (CI): 0.52-0.68], and rivaroxaban (HR: 0.75, 95% CI: 0.69-0.83) were associated with a lower risk of stroke/SE. Apixaban (HR: 0.57, 95% CI: 0.54-0.61) and dabigatran (HR: 0.76, 95% CI: 0.66-0.88) were associated with a decreased risk of MB compared with warfarin. Compared with dabigatran and rivaroxaban, apixaban was associated with a lower risk of stroke/SE and MB. Dabigatran was associated with lower risk of MB compared with rivaroxaban. CONCLUSIONS: In this observational study of anticoagulated NVAF patients with polypharmacy, effectiveness and safety profiles are more favourable for NOACs vs. warfarin. Our observations are hypothesis generating and may help inform future clinical trials regarding appropriate OAC treatment selection in polypharmacy patients. Published on behalf of the European Society of Cardiology.
Authors: Benjamin J R Buckley; Deirdre A Lane; Peter Calvert; Juqian Zhang; David Gent; C Daniel Mullins; Paul Dorian; Shun Kohsaka; Stefan H Hohnloser; Gregory Y H Lip Journal: J Clin Med Date: 2022-06-30 Impact factor: 4.964
Authors: Anne Grete Semb; Silvia Rollefstad; Joseph Sexton; Eirik Ikdahl; Cynthia S Crowson; Piet van Riel; George Kitas; Ian Graham; Anne M Kerola Journal: Int J Cardiol Heart Vasc Date: 2022-09-12