In NVAF patients with ESRD or receiving dialysis, rivaroxaban was associated with similar risks of stroke or systemic embolism compared to apixaban (HR 1.18; 95% CI 0.53-2.63).
Cohort (n=2,623)
Yes
Does rivaroxaban compared to apixaban reduce stroke, systemic embolism, or major bleeding in non-valvular atrial fibrillation patients with end-stage renal disease or receiving dialysis?
In real-world practice, rivaroxaban and apixaban demonstrate similar effectiveness and safety profiles in patients with non-valvular atrial fibrillation and end-stage renal disease.
Effect estimate: HR 1.18 (95% CI 0.53-2.63)
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.
Miao et al. (Sat,) conducted a cohort in Non-valvular atrial fibrillation with end-stage renal disease and/or receiving dialysis (n=2,623). Rivaroxaban vs. Apixaban was evaluated on Stroke or systemic embolism (SSE) (HR 1.18, 95% CI 0.53-2.63). In NVAF patients with ESRD or receiving dialysis, rivaroxaban was associated with similar risks of stroke or systemic embolism compared to apixaban (HR 1.18; 95% CI 0.53-2.63).