Rivaroxaban was associated with similar risks of ischemic stroke or systemic embolism (OR 0.88; 95% CI 0.60-1.28) and major bleeding compared to warfarin in morbidly obese patients with AF.
Cohort (n=7,126)
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Does rivaroxaban reduce ischemic stroke/systemic embolism, major bleeding, and healthcare costs compared to warfarin in morbidly obese patients with atrial fibrillation?
In morbidly obese patients with atrial fibrillation, rivaroxaban showed comparable efficacy and safety to warfarin but was associated with significantly lower healthcare resource utilization and costs.
Odds Ratio: 0.88 (95% CI 0.6–1.28)
Tasa de eventos absoluta: 1.5% vs 1.7%
valor p: p=.5028
BACKGROUND: or body weight >120 kg). METHODS: Using data from 2 US healthcare claims databases, we identified patients initiating rivaroxaban or warfarin who had ≥1 medical claim with an AF diagnosis, a diagnostic code for morbid obesity (ICD-9: 278. 01, V85. 4%; ICD-10: E66. 01%, E66. 2%, Z68. 4%), and a minimum continuous enrollment of 12 months before and 3 months after treatment initiation. Patients were excluded if they had mitral stenosis, a mechanical heart valve procedure, an organ/tissue transplant, or an oral anticoagulant prescription prior to the index date. Rivaroxaban and warfarin patients were 1: 1 propensity score matched. Conditional logistic regression was used to compare ischemic stroke/systemic embolism and major bleeding risk. Generalized linear models were used to compare healthcare resource utilization and costs. RESULTS: A total of 3563 matched pairs of morbidly obese AF patients treated with rivaroxaban or warfarin were identified. The majority (81. 4%) of patients in the rivaroxaban cohort were receiving the 20 mg dose. The rivaroxaban and warfarin cohorts were well balanced after propensity score matching. The risks of ischemic stroke/systemic embolism and major bleeding were similar for rivaroxaban and warfarin users (stroke/systemic embolism: 1. 5% vs 1. 7%; odds ratio OR: 0. 88; 95% confidence interval CI: 0. 60, 1. 28; P =. 5028; major bleeding: 2. 2% vs 2. 7%; OR: 0. 80; 95% CI: 0. 59, 1. 08; P =. 1447). Total healthcare costs including medication costs per patient per year (PPPY) were significantly lower with rivaroxaban versus warfarin (48, 552 vs 52, 418; P =. 0025), which was primarily driven by lower hospitalization rate (50. 2% vs 54. 1%; P =. 0008), shorter length of stay (7. 5 vs 9. 1 days; P =. 0010), and less outpatient service utilization (86 vs 115 visits PPPY; P <. 0001). CONCLUSIONS: Morbidly obese AF patients treated with rivaroxaban had comparable risk of ischemic stroke/systemic embolism and major bleeding as those treated with warfarin, but lower healthcare resource utilization and costs.
Peterson et al. (Wed,) conducted a cohort in Atrial fibrillation and morbid obesity (n=7,126). Rivaroxaban vs. Warfarin was evaluated on Ischemic stroke/systemic embolism (OR 0.88, 95% CI 0.60, 1.28, p=.5028). Rivaroxaban was associated with similar risks of ischemic stroke or systemic embolism (OR 0.88; 95% CI 0.60-1.28) and major bleeding compared to warfarin in morbidly obese patients with AF.