Comparison of Effectiveness and Safety of Treatment with Apixaban vs. Other Oral Anticoagulants Among Elderly Nonvalvular Atrial Fibrillation Patients.

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Comparison of Effectiveness and Safety of Treatment with Apixaban vs. Other Oral Anticoagulants Among Elderly Nonvalvular Atrial Fibrillation Patients.

Curr Med Res Opin. 2017 May 23;:1-25

Authors: Deitelzweig S, Luo X, Gupta K, Trocio J, Mardekian J, Curtice T, Lingohr-Smith M, Menges B, Lin J

Abstract
OBJECTIVE: To compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) of elderly (≥65 years of age) nonvalvular atrial fibrillation (NVAF) patients initiating apixaban vs. rivaroxaban, dabigatran, or warfarin.
METHODS: NVAF patients with Medicare Advantage coverage in the US initiating oral anticoagulants (OACs, index event) were identified from the Humana database (1/1/2013-9/30/2015) and grouped into cohorts depending on OAC initiated. Propensity score matching (PSM), 1:1, was conducted among patients treated with apixaban vs. each other OAC, separately. Rates of S/SE and MB were evaluated in the follow-up. Cox regressions were used to compare the risk of S/SE and MB between apixaban and each of the other OACs during the follow-up.
RESULTS: The matched pairs of apixaban vs. rivaroxaban (n = 13,620), apixaban vs. dabigatran (n = 4,654), and apixaban vs. warfarin (n = 14,214) were well balanced for key patient characteristics. Adjusted risks for S/SE (hazard ratio [HR] vs. rivaroxaban: 0.72, p = 0.003; vs. warfarin: 0.65, p < 0.001) and MB (HR vs. rivaroxaban: 0.49, p < 0.001; vs. warfarin: 0.53, p < 0.001) were significantly lower during the follow-up for patients treated with apixaban vs. rivaroxaban and warfarin. Adjusted risks for S/SE (HR: 0.78, p = 0.27) and MB (HR: 0.82, p = 0.23) of NVAF patients treated with apixaban vs. dabigatran trended to be lower, but did not reach statistical significance.
CONCLUSIONS: In the real-world setting after controlling for differences in patient characteristics, apixaban is associated with significantly lower risk of S/SE and MB than rivaroxaban and warfarin, and a trend towards better outcomes vs. dabigatran among elderly NVAF patients in the US.

PMID: 28535119 [PubMed - as supplied by publisher]

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