Safety and Effectiveness of Apixaban in Very Elderly Patients with Atrial Fibrillation: A Retrospective Analysis of Japanese Administrative Claims Data.
IF 3
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
引用次数: 0
Abstract
Introduction: Anticoagulation is a well-established treatment for patients with atrial fibrillation (AF) for the prevention of stroke/systemic embolism (SE). However, although nearly all elderly patients with AF are at risk for thrombotic events, they also have a heightened risk of bleeding, and evidence regarding the optimal anticoagulation regimen in very elderly patients remains limited. This study aimed to evaluate the safety and effectiveness of apixaban versus warfarin in a cohort of very elderly patients with AF in Japan.
Methods: This was a retrospective analysis of administrative claims for patients with AF newly initiated on apixaban or warfarin from acute care hospitals. Clinical and demographic characteristics were balanced between cohorts using an inverse probability of treatment weighting with stabilized weights (s-IPTW) method. Prespecified subgroup analyses were also conducted to assess treatment interaction with some baseline/demographic factors.
Results: A total of 77,814 eligible patients with AF were balanced between the apixaban group (N = 33,834) and warfarin group (N = 43,671) using s-IPTW. The incidence of stroke/SE-primary effectiveness outcome-was 55.8 and 75.2 per 1000 person-years and that of major bleeding-primary safety outcome-was 17.3 and 25.3 per 1000 person-years in the apixaban and warfarin groups, respectively. Apixaban was associated with a significantly lower risk of stroke/SE (hazard ratio [HR], 0.75; 95% confidence interval [CI] [0.71-0.80], P < 0.001) and major bleeding (HR, 0.69; 95% CI [0.62-0.76], P < 0.001). Consistent trends were observed across all prespecified secondary outcomes. Additionally, there was no evidence of interaction between treatment and the variables examined, such as age, number of medications, Charlson Comorbidity Index, and activities of daily living.
Conclusions: In very elderly patients with AF, apixaban was associated with a significantly lower risk of stroke/SE and bleeding compared with warfarin.
Trial registration: ClinicalTrials.gov identifier NCT05438888.
阿哌沙班治疗高龄心房颤动的安全性和有效性：日本行政索赔数据的回顾性分析。
抗凝治疗是房颤（AF）患者预防卒中/全身性栓塞（SE）的一种行之有效的治疗方法。然而，尽管几乎所有老年房颤患者都有血栓形成事件的风险，但他们也有较高的出血风险，而且关于老年患者最佳抗凝治疗方案的证据仍然有限。本研究旨在评价阿哌沙班与华法林在日本一组老年房颤患者中的安全性和有效性。方法：回顾性分析急性护理医院新开始使用阿哌沙班或华法林治疗的房颤患者的行政索赔。使用稳定权重（s-IPTW）方法的治疗加权逆概率来平衡各队列之间的临床和人口学特征。还进行了预先指定的亚组分析，以评估治疗与一些基线/人口因素的相互作用。结果：使用s-IPTW在阿哌沙班组（N = 33,834）和华法林组（N = 43,671）之间平衡了77,814例符合条件的房颤患者。在阿哌沙班组和华法林组中，卒中/ se2主要有效性结局的发生率分别为55.8 / 1000人年和75.2 / 1000人年，主要出血主要安全性结局的发生率分别为17.3 / 1000人年和25.3 / 1000人年。阿哌沙班与卒中/SE风险显著降低相关(风险比[HR]， 0.75；95%可信区间[CI] [0.71-0.80]， P结论：与华法林相比，在高龄房颤患者中，阿哌沙班与卒中/SE和出血的风险显著降低相关。试验注册：ClinicalTrials.gov识别码NCT05438888。
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来源期刊
Cardiology and Therapy
CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.30
自引率
0.00%
发文量
38
审稿时长
6 weeks
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Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged.
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