Effectiveness and Safety of Oral Anticoagulants among NVAF Patients with Obesity: Insights from the ARISTOPHANES Study
Effectiveness and Safety of Oral Anticoagulants among NVAF Patients with Obesity: Insights from the ARISTOPHANES Study
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DOI：
10.3390/jcm9061633
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发表时间：
2020-06-01
影响因子：
3.9
通讯作者：
Lip, Gregory Y. H.
中科院分区：
文献类型：
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作者：
Deitelzweig, Steve;Keshishian, Allison;Lip, Gregory Y. H.
该ARISTOPHANES分析检查了接受华法林或非维生素K拮抗剂口服抗凝剂（NOAC）处方的肥胖非瓣膜性房颤（NVAF）患者亚组中的卒中/全身性栓塞（SE）和大出血（MB），以便为临床决策提供信息。在2013年1月1日至2015年9月30日期间接受阿哌沙班、达比加群、利伐沙班或华法林治疗的肥胖NVAF患者中进行了一项回顾性观察性研究，数据汇总自CMS Medicare和4个美国商业索赔数据库。在每个数据库中完成NOAC之间和华法林之间的倾向评分匹配，并汇总结果。使用考克斯模型评价卒中/SE和MB的风险。共有88，461名肥胖患者被纳入研究。与华法林相比，阿哌沙班和利伐沙班与卒中/SE风险较低相关（HR：0.63，95% CI：0.49-0.82和HR：0.84，95% CI：0.72-0.98）。与华法林相比，达比加群与卒中/SE风险相似。与华法林相比，阿哌沙班和达比加群的MB风险较低（HR：0.54，95% CI：0.49-0.61和HR：0.75，95% CI：0.63-0.91）。与华法林相比，利伐沙班与MB的风险相似。在这一肥胖高风险人群中，NOAC与华法林相比，卒中/SE和MB的风险不同。
This ARISTOPHANES analysis examined stroke/systemic embolism (SE) and major bleeding (MB) among a subgroup of nonvalvular atrial fibrillation (NVAF) patients with obesity prescribed warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) in order to inform clinical decision making. A retrospective observational study was conducted among NVAF patients who were obese and initiated apixaban, dabigatran, rivaroxaban, or warfarin from 1 January 2013-30 September 2015, with data pooled from CMS Medicare and four US commercial claims databases. Propensity score matching was completed between NOACs and against warfarin in each database, and the results were pooled. Cox models were used to evaluate the risks of stroke/SE and MB. A total of 88,461 patients with obesity were included in the study. Apixaban and rivaroxaban were associated with a lower risk of stroke/SE vs. warfarin (HR: 0.63, 95% CI: 0.49-0.82 and HR: 0.84, 95% CI: 0.72-0.98). Dabigatran was associated with a similar risk of stroke/SE compared to warfarin. Compared with warfarin, apixaban and dabigatran had a lower risk of MB (HR: 0.54, 95% CI: 0.49-0.61 and HR: 0.75, 95% CI: 0.63-0.91). Rivaroxaban was associated with a similar risk of MB compared to warfarin. In this high-risk population with obesity, NOACs had a varying risk of stroke/SE and MB vs. warfarin.