Effectiveness and safety of apixaban and rivaroxaban vs warfarin in patients with atrial fibrillation and chronic kidney disease  

作　　者：Sylvie Perreault Laurie-Anne Boivin Proulx Aurélie Lenglet Ziad A Massy Marc Dorais 

机构地区：[1]Faculty of Pharmacy,University of Montreal,Quebec,Montreal H3C3J7,Canada [2]Department of Cardiology,Faculty of Medicine,University of Ottawa Heart Institute,Ontario,Ottawa K1Y4W7,Canada [3]Department of Pharmacy,Amiens-Picardie Hospital University Center,Amiens 80000,France [4]Faculty of Pharmacy,MP3CV Laboratory,UR7545,University of Picardie Jules Verne,Amiens 80000,France [5]Division of Nephrology,University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines(UVSQ),Villejuif,France.,AP-HP Ambroise-ParéHospital,Boulogne Billancourt/Paris 92104,France [6]StatSciences Inc.,Notre-Dame-de-l’Île-Perrot,Quebec,Montreal J7W 3K8,Canada

出　　处：《World Journal of Nephrology》2023年第5期132-146,共15页世界肾病学杂志（英文版）

摘　　要：BACKGROUND Randomized controlled trials(RCTs)of direct oral anticoagulants(DOACs)included a low proportion of atrial fibrillation(AF)patients with chronic kidney disease(CKD),and suggested that DOACs are safe and effective in patients with mild-to-moderate CKD.In a metanalysis of RCTs and observational studies,DOACs were associated with better efficacy(vs warfarin)in early CKD and had similar efficacy and safety profiles in patients with stages IV-V CKD.But few studies have provided data on the safety and effectiveness of each DOAC vs warfarin in patients with stage III CKD.The effectiveness and safety of DOACs in those patients are still subject to debate.AIM To assess and compare the effectiveness and safety of apixaban and rivaroxaban vs warfarin in this patient population.METHODS A cohort of patients with an inpatient or outpatient code for AF and stage III CKD who were newly prescribed apixaban and rivaroxaban was created using the administrative databases from the Quebec province of Canada between 2013 and 2017.The primary effectiveness outcome was a composite of ischemic stroke,systemic embolism,and death,whereas the primary safety outcome was a composite of major bleeding within a year of DOAC vs warfarin initiation.Treatment groups were compared in an under-treatment analysis using inverse probability of treatment weighting and Cox proportional hazards.RESULTS A total of 8899 included patients filled out a new oral anticoagulation therapy claim;3335 for warfarin and 5564 for DOACs.Compared with warfarin,15 mg and 20 mg rivaroxaban presented a similar effectiveness and safety composite risk.Apixaban 5.0 mg was associated with a lower effectiveness composite risk[Hazard ratio(HR)0.76;95%confidence interval(CI):0.65-0.88]and a similar safety risk(HR 0.94;95%CI:0.66-1.35).Apixaban 2.5 mg was associated with a similar effectiveness composite(HR 1.00;95%CI:0.79-1.26)and a lower safety risk(HR 0.65;95%CI:0.43-0.99.Although,apixaban 5.0 mg was associated with a better effectiveness(HR 0.76;95%CI:0.65-0.88),but a

关 键 词：Atrial fibrillation Chronic kidney disease Direct oral anticoagulant EFFECTIVENESS SAFETY WARFARIN 

分 类 号：F42[经济管理—产业经济]