Abstract | BACKGROUND: METHODS: This was an analysis of Optum® De-Identified electronic health record data from 11/2010 to 12/2019. We included adults with nonvalvular atrial fibrillation and type 2 diabetes, newly started on rivaroxaban or warfarin and with ≥ 12-months of prior electronic health record activity. Patients who were pregnant, had alternative indications for oral anticoagulation or valvular heart disease were excluded. We evaluated the incidence rate (%/year) of developing the composite outcome of stroke/systemic embolism or vascular death and major or clinically relevant nonmajor bleeding as well as each endpoint individually. Hazard ratios with 95% confidence intervals were calculated using propensity score-overlap weighted proportional hazards regression. RESULTS: We included 32,078 rivaroxaban (31% initiated on 15 mg dose) and 83,971warfarin users (time-in-therapeutic range = 47 ± 28%). Rivaroxaban was associated with a reduced risk of stroke/systemic embolism or vascular death (3.79 vs. 4.19; hazard ratio = 0.91, 95% confdience interval = 0.88-0.95), driven mostly by reductions in vascular death (2.81 vs 3.18, hazard ratio = 0.90, 95% confidence interval = 0.86-0.95) and systemic embolism (0.13 vs. 0.16; hazard ratio = 0.82, 95% confidence interval = 0.66-1.02). Major/clinically relevant nonmajor bleeding was less frequent with rivaroxaban versus warfarin (2.17 vs. 2.31; hazard ratio = 0.94, 95% confidence interval = 0.89-0.99) due to decreased critical organ bleeding (including intracranial hemorrhage) (0.35 vs. 0.54; hazard ratio = 0.63, 95% confidence interval = 0.55-0.72). CONCLUSIONS:
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Authors | Craig I Coleman, Olivia S Costa, Christopher W Brescia, Burcu Vardar, Khaled Abdelgawwad, Nitesh Sood |
Journal | Cardiovascular diabetology
(Cardiovasc Diabetol)
Vol. 20
Issue 1
Pg. 52
(02 26 2021)
ISSN: 1475-2840 [Electronic] England |
PMID | 33637082
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anticoagulants
- Factor Xa Inhibitors
- Warfarin
- Rivaroxaban
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Topics |
- Aged
- Aged, 80 and over
- Anticoagulants
(adverse effects, therapeutic use)
- Atrial Fibrillation
(diagnosis, drug therapy, mortality)
- Comorbidity
- Diabetes Mellitus, Type 2
(diagnosis, epidemiology, mortality)
- Electronic Health Records
- Factor Xa Inhibitors
(adverse effects, therapeutic use)
- Female
- Hemorrhage
(chemically induced)
- Humans
- Incidence
- Male
- Middle Aged
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Rivaroxaban
(adverse effects, therapeutic use)
- Thromboembolism
(diagnosis, mortality, prevention & control)
- Time Factors
- Treatment Outcome
- Warfarin
(adverse effects, therapeutic use)
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