Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Severe Kidney Disease or Undergoing Hemodialysis

Coleman, Craig I.; Kreutz, Reinhold; Sood, Nitesh; Bunz, Thomas J.; Eriksson, Daniel; Meinecke, Anna‐Katharina; Baker, William L.

doi:10.1016/j.amjmed.2019.04.013

Cited by 107 publications

(108 citation statements)

References 11 publications

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“…Apixaban patients (n = 2351) were 1:3 propensity score‐matched to warfarin patients (n = 7053); while the investigators found no difference in SSE (HR = 0.88, 95% CI = 0.69‐1.12), they did find apixaban was associated with a lower risk of major bleeding versus warfarin (HR = 0.72, 95%CI = 0.59‐0.87). Coleman and colleagues . compared rivaroxaban to warfarin in NVAF patients with severe CKD and/or undergoing dialysis using the MarketScan databases.…”

Section: Discussionmentioning

confidence: 99%

“…An interesting finding of the current body of real‐world evidence is the frequent use of the standard doses of apixaban and rivaroxaban among patients with ESRD/receiving dialysis (the standard dose was used in 44%‐71% of evaluated patients in these studies). An early (2010‐2014) evaluation by Chan and colleagues demonstrated the rivaroxaban dose used in NVAF patients receiving dialysis was inconsistent and fluctuated over time.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical outcomes associated with the use of apixaban and rivaroxaban versus warfarin in NVAF patients with ESRD and/or dialysis are each supported by a lone retrospective study. 16,17 Siontis and colleagues 16 Abbreviations: CI, confidence interval; HR, hazard ratio; IPTW, inverse probability-of-treatment weighting. and the Centers for Medicare and Medicaid Services.…”

Section: Clinical Relevancementioning

confidence: 99%

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Rivaroxaban versus apixaban in non‐valvular atrial fibrillation patients with end‐stage renal disease or receiving dialysis

Miao

Sood

Bunz³

et al. 2020

European J of Haematology

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Objectives We sought to evaluate the effectiveness and safety of rivaroxaban vs apixaban in non‐valvular atrial fibrillation (NVAF) patients with end‐stage renal disease (ESRD) and/or receiving dialysis in routine practice. Methods Using US MarketScan claims data from January 1, 2014, to December 31, 2017, we identified new‐users of rivaroxaban or apixaban during 2015 with at least 12 months of insurance coverage prior to oral anticoagulant (OAC) initiation. Differences in baseline covariates between cohorts were adjusted using inverse probability‐of‐treatment weighting based on propensity scores. Patients were followed for stroke or systemic embolism (SSE) or major bleeding hospitalizations. Cox proportion hazards regression was used to compare rivaroxaban and apixaban. Analyses stratified by age, sex, CHA2DS2‐VASc score, prior stroke, prior bleed, diabetes, and reduced OAC dose were performed. Results We identified 787 rivaroxaban and 1836 apixaban users. Median (25, 75% range) age = 70 (61, 79), CHA2DS2‐VASc score = 3 (2, 4), and follow‐up = 0.87 (0.38, 1.56) years. No differences in the risks of SSE (HR = 1.18, 95% CI = 0.53‐2.63), ischemic stroke (HR = 1.12, 95%CI = 0.45‐2.76), or major bleeding (HR = 1.00, 95% CI = 0.63‐1.58) were observed. No significant interactions were observed upon subgroup analysis. Conclusion In NVAF patients with ESRD and/or receiving dialysis, rivaroxaban and apixaban were associated with similar risks of SSE and major bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Relevancementioning

confidence: 99%

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Rivaroxaban versus apixaban in non‐valvular atrial fibrillation patients with end‐stage renal disease or receiving dialysis

Miao

Sood

Bunz³

et al. 2020

European J of Haematology

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“…The 2019 AHA/ACC/HRS guideline recommends that it might be reasonable to prescribe warfarin (INR 2.0 to 3.0) or apixaban for oral anticoagulation to patients with AF who have a CHA 2 DS 2 -VASc score of 2 or greater in men or 3 or greater in women and those who have end-stage chronic kidney disease (CKD; creatinine clearance [CrCl] <15 mL/min) or are on dialysis (Class of Recommendation IIb, Level of Evidence B-NR) [8]. In a large United States claims database analysis evaluating patients with AF and stage 4 or 5 CKD or undergoing hemolysis, rivaroxaban appeared to be associated with less major bleeding compared with warfarin in patients with severe kidney dysfunction (HR 0.68; 95% CI, 0.47-0.99) [18]. In 2018, Siontis et al published a study comparing apixaban to warfarin among patients with nonvalvular AF undergoing hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes among Hemodialysis Patients with Atrial Fibrillation: A Korean Nationwide Population-based Study

Kang

Choi

Kwon

et al. 2019

Preprint

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Background: The number of patients requiring dialysis is increasing worldwide, and the atrial fibrillation (AF) prevalence among hemodialysis (HD) patients is higher than in the general population. There have been no studies of Korean AF patients undergoing HD investigating how AF affects outcomes, for example, in terms of all-cause mortality, hospitalization, and stroke events. We conducted a large-scale retrospective cohort study with data from the National Health Insurance System (NHIS) to determine how AF affects these outcomes. Methods: In 2013, the Health Insurance Review and Assessment (HIRA) service, a Korean national health insurance scheme, collected data from 21,839 HD patients for evaluating the adequacy of dialysis centers. All-cause mortality, hospitalization, and stroke events were compared between patients with and without AF. Sub-analyses compared these outcomes between patients receiving and not receiving warfarin. Results: Cox regression analysis found that AF was a significant risk factor for death from any cause (HR, 1.356; 95% CI, 1.222-1.506, P < 0.001), hospitalization (HR, 1.323; 95% CI, 1.225-1.430, P < 0.001), and hemorrhagic stroke (HR, 1.500; 95% CI, 1.050-2.141, P = 0.026). AF was not significantly associated with an increased risk of ischemic stroke. The use of warfarin was significantly associated with hemorrhagic stroke incidence (HR, 1.593; 95% CI, 1.075-2.360, P = 0.020), while there was no significant correlation between warfarin treatment and all-cause mortality, hospitalization, and ischemic stroke. Conclusions: This cohort study of Korean dialysis patients showed that AF was a risk factor for multiple outcomes among HD patients.

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“…Ривароксабан не показал преимущества в снижении частоты инсульта или системной эмболии по сравнению с варфарином. Однако прием ривароксабана снижал общее количество фатальных кровотечений на 32% по сравнению с варфарином [23].…”

Section: таблица 3 использование антиаритмических препаратов и препаunclassified

Atrial fibrillation in patients with chronic kidney disease

Melnikov

Yashin

2020

Vestnik aritmologii

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Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Severe Kidney Disease or Undergoing Hemodialysis

Cited by 107 publications

References 11 publications

Rivaroxaban versus apixaban in non‐valvular atrial fibrillation patients with end‐stage renal disease or receiving dialysis

Rivaroxaban versus apixaban in non‐valvular atrial fibrillation patients with end‐stage renal disease or receiving dialysis

Clinical Outcomes among Hemodialysis Patients with Atrial Fibrillation: A Korean Nationwide Population-based Study

Atrial fibrillation in patients with chronic kidney disease

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