利伐沙班与其他口服抗凝药对患有非瓣膜性心房颤动的老年人的有效性和安全性比较:根据更新后的 Beers 标准进行的人群分析。

IF 5.5 2区 医学 Q1 HEMATOLOGY Journal of Thrombosis and Haemostasis Pub Date : 2024-10-21 DOI:10.1016/j.jtha.2024.10.009
Ghadeer K Dawwas, Adam Cuker
{"title":"利伐沙班与其他口服抗凝药对患有非瓣膜性心房颤动的老年人的有效性和安全性比较:根据更新后的 Beers 标准进行的人群分析。","authors":"Ghadeer K Dawwas, Adam Cuker","doi":"10.1016/j.jtha.2024.10.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Concerns have been raised regarding the updated Beers Criteria that recommended avoiding rivaroxaban use for long-term treatment of older adults with nonvalvular atrial fibrillation (AF).</p><p><strong>Objectives: </strong>We sought to compare the effectiveness and safety of rivaroxaban with oral anticoagulants in older adults with nonvalvular AF.</p><p><strong>Methods: </strong>We used an administrative healthcare database and included adults with AF aged ≥65 years who were new users of rivaroxaban or the comparators. We created 3 pairwise comparisons: rivaroxaban vs warfarin; rivaroxaban vs dabigatran; and rivaroxaban vs apixaban. Study outcomes included stroke or systemic embolism (effectiveness) and gastrointestinal or intracranial bleeding (safety). In the propensity score-matched sample, we used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs.</p><p><strong>Results: </strong>In the matched cohorts, use of rivaroxaban (vs warfarin) increased risk of bleeding (HR, 1.13; 95% CI, 1.03-1.23) with no difference in ischemic stroke or systemic embolism (HR, 0.90; 95% CI, 0.79-1.02); use of rivaroxaban (vs dabigatran) increased risk of bleeding (HR, 1.18; 95% CI, 1.03-1.35) with no difference in ischemic stroke and systemic embolism (HR, 1.00; 95% CI, 0.83-1.22); and use of rivaroxaban (vs apixaban) increased risk of stroke and systemic embolism (HR, 1.23; 95% CI, 1.08-1.40) and bleeding (HR, 1.60; 95% CI, 1.45-1.76).</p><p><strong>Conclusion: </strong>In this comparative effectiveness and safety study of older adults with nonvalvular AF, use of rivaroxaban was associated with a significantly increased risk of ischemic stroke and systemic embolism compared with apixaban and bleeding compared with warfarin, dabigatran, and apixaban. Our findings may inform anticoagulant selection in older adults with nonvalvular AF.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5000,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative effectiveness and safety of rivaroxaban with other oral anticoagulants in older adults with nonvalvular atrial fibrillation: population-based analysis in response to updated Beers Criteria.\",\"authors\":\"Ghadeer K Dawwas, Adam Cuker\",\"doi\":\"10.1016/j.jtha.2024.10.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Concerns have been raised regarding the updated Beers Criteria that recommended avoiding rivaroxaban use for long-term treatment of older adults with nonvalvular atrial fibrillation (AF).</p><p><strong>Objectives: </strong>We sought to compare the effectiveness and safety of rivaroxaban with oral anticoagulants in older adults with nonvalvular AF.</p><p><strong>Methods: </strong>We used an administrative healthcare database and included adults with AF aged ≥65 years who were new users of rivaroxaban or the comparators. We created 3 pairwise comparisons: rivaroxaban vs warfarin; rivaroxaban vs dabigatran; and rivaroxaban vs apixaban. Study outcomes included stroke or systemic embolism (effectiveness) and gastrointestinal or intracranial bleeding (safety). In the propensity score-matched sample, we used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs.</p><p><strong>Results: </strong>In the matched cohorts, use of rivaroxaban (vs warfarin) increased risk of bleeding (HR, 1.13; 95% CI, 1.03-1.23) with no difference in ischemic stroke or systemic embolism (HR, 0.90; 95% CI, 0.79-1.02); use of rivaroxaban (vs dabigatran) increased risk of bleeding (HR, 1.18; 95% CI, 1.03-1.35) with no difference in ischemic stroke and systemic embolism (HR, 1.00; 95% CI, 0.83-1.22); and use of rivaroxaban (vs apixaban) increased risk of stroke and systemic embolism (HR, 1.23; 95% CI, 1.08-1.40) and bleeding (HR, 1.60; 95% CI, 1.45-1.76).</p><p><strong>Conclusion: </strong>In this comparative effectiveness and safety study of older adults with nonvalvular AF, use of rivaroxaban was associated with a significantly increased risk of ischemic stroke and systemic embolism compared with apixaban and bleeding compared with warfarin, dabigatran, and apixaban. Our findings may inform anticoagulant selection in older adults with nonvalvular AF.</p>\",\"PeriodicalId\":17326,\"journal\":{\"name\":\"Journal of Thrombosis and Haemostasis\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.5000,\"publicationDate\":\"2024-10-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Thrombosis and Haemostasis\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jtha.2024.10.009\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thrombosis and Haemostasis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jtha.2024.10.009","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

目的:鉴于最近对更新后的比尔斯标准的担忧,我们试图比较利伐沙班与口服抗凝药对患有非瓣膜性心房颤动(房颤)的老年人的有效性和安全性:我们使用了一个行政医疗数据库,纳入了年龄≥ 65 岁、新使用利伐沙班或比较药的房颤患者。我们建立了三个配对比较:利伐沙班与华法林;利伐沙班与达比加群;利伐沙班与阿哌沙班。研究结果包括中风或全身性栓塞(有效性)以及胃肠道或颅内出血(安全性)。在倾向评分匹配样本中,我们使用 Cox 比例危险回归估算危险比 [HRs] 和 95% 置信区间 [CIs]:在配对队列中,使用利伐沙班(与华法林相比)会增加出血风险(HR 1.13;CI 1.03 至 1.23),但缺血性卒中或全身性栓塞的风险没有差异(HR 0.90;CI 0.79 至 1.02);使用利伐沙班(与达比加群相比)会增加出血风险(HR 1.18;CI 1.03至1.35),缺血性卒中和全身性栓塞无差异(HR 1.00;CI 0.83至1.22);使用利伐沙班(与阿哌沙班相比)会增加卒中和全身性栓塞(HR 1.23;CI 1.08至1.40)以及出血(HR 1.60;CI 1.45至1.76)的风险:在这项针对老年非瓣膜性房颤患者的有效性和安全性比较研究中,与阿哌沙班相比,使用利伐沙班会显著增加缺血性中风和全身性栓塞的风险;与华法林、达比加群和阿哌沙班相比,使用利伐沙班会显著增加出血的风险。我们的研究结果可为患有非瓣膜性房颤的老年人选择抗凝药物提供参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Comparative effectiveness and safety of rivaroxaban with other oral anticoagulants in older adults with nonvalvular atrial fibrillation: population-based analysis in response to updated Beers Criteria.

Background: Concerns have been raised regarding the updated Beers Criteria that recommended avoiding rivaroxaban use for long-term treatment of older adults with nonvalvular atrial fibrillation (AF).

Objectives: We sought to compare the effectiveness and safety of rivaroxaban with oral anticoagulants in older adults with nonvalvular AF.

Methods: We used an administrative healthcare database and included adults with AF aged ≥65 years who were new users of rivaroxaban or the comparators. We created 3 pairwise comparisons: rivaroxaban vs warfarin; rivaroxaban vs dabigatran; and rivaroxaban vs apixaban. Study outcomes included stroke or systemic embolism (effectiveness) and gastrointestinal or intracranial bleeding (safety). In the propensity score-matched sample, we used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs.

Results: In the matched cohorts, use of rivaroxaban (vs warfarin) increased risk of bleeding (HR, 1.13; 95% CI, 1.03-1.23) with no difference in ischemic stroke or systemic embolism (HR, 0.90; 95% CI, 0.79-1.02); use of rivaroxaban (vs dabigatran) increased risk of bleeding (HR, 1.18; 95% CI, 1.03-1.35) with no difference in ischemic stroke and systemic embolism (HR, 1.00; 95% CI, 0.83-1.22); and use of rivaroxaban (vs apixaban) increased risk of stroke and systemic embolism (HR, 1.23; 95% CI, 1.08-1.40) and bleeding (HR, 1.60; 95% CI, 1.45-1.76).

Conclusion: In this comparative effectiveness and safety study of older adults with nonvalvular AF, use of rivaroxaban was associated with a significantly increased risk of ischemic stroke and systemic embolism compared with apixaban and bleeding compared with warfarin, dabigatran, and apixaban. Our findings may inform anticoagulant selection in older adults with nonvalvular AF.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis 医学-外周血管病
CiteScore
24.30
自引率
3.80%
发文量
321
审稿时长
1 months
期刊介绍: The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
期刊最新文献
Real-World Safety and Efficacy of rADAMTS13 in the Treatment of Congenital Thrombotic Thrombocytopenic Purpura in Pediatric Patients in Poland. Guidelines and Guidance: What is the path forward for the International Society on Thrombosis and Haemostasis? JTH in Clinic - Choosing the optimal oral anticoagulant for stroke prevention in atrial fibrillation: direct oral anticoagulants vs. vitamin K antagonists. Use of antithrombotic therapy in patients with hemophilia: A selected synopsis of the EHA-ISTH-EAHAD-ESO Clinical Practice Guidance document. High-dose IVIG and usual heparin anticoagulation for urgent cardiac surgery in a patient with severe autoimmune HIT.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1