Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation
Background: Real-world evidence on direct oral anticoagulant outcomes among Non-Valvular Atrial Fibrillation (NVAF) patients is limited. We aimed to evaluate stroke/systemic embolism (SE) and major bleeding (MB) risks among NVAF patients continuing or switching to different oral anticoagulants. Meth...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/4/1073 |
| _version_ | 1797297873854922752 |
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| author | Steven Deitelzweig Amiee Kang Jenny Jiang Chuan Gao Xuemei Luo Nipun Atreja Stella Han Dong Cheng Saarusri R Loganathan Gregory Y. H. Lip |
| author_facet | Steven Deitelzweig Amiee Kang Jenny Jiang Chuan Gao Xuemei Luo Nipun Atreja Stella Han Dong Cheng Saarusri R Loganathan Gregory Y. H. Lip |
| author_sort | Steven Deitelzweig |
| collection | DOAJ |
| description | Background: Real-world evidence on direct oral anticoagulant outcomes among Non-Valvular Atrial Fibrillation (NVAF) patients is limited. We aimed to evaluate stroke/systemic embolism (SE) and major bleeding (MB) risks among NVAF patients continuing or switching to different oral anticoagulants. Methods: Using Optum’s de-identified Clinformatics® Data Mart Database, we identified NVAF patients initiating apixaban or rivaroxaban between 1 January 2013 and 31 December 2021. Patients switching therapies within 30 days before or 90 days after discontinuing their initial DOAC and those who continued initial therapy were included. The index date was the switch date for switchers, while continuers were assigned a hypothetic index date. Switchers and continuers were propensity score matched based on pre-index characteristics. Results: Among 167,868 apixaban and 65,888 rivaroxaban initiators, 2900 apixaban-to-rivaroxaban switchers were matched with 14,500 apixaban continuers, and 2873 rivaroxaban-to-apixaban switchers were matched with 14,365 rivaroxaban continuers. Apixaban-to-rivaroxaban switching was associated with higher stroke/SE risk (HR: 1.99, 95% CI: 1.38–2.88) and MB risk (HR:1.80, 95% CI: 1.46–2.23) than continuing apixaban. Rivaroxaban-to-apixaban switching had similar stroke/SE risk (HR: 0.74, 95% CI: 0.45–1.22) but lower MB risk (HR: 0.49, 95% CI: 0.38–0.65) than continuing rivaroxaban. Conclusions: These findings may aid physicians and patients in making informed decisions when considering a switch between apixaban and rivaroxaban. |
| first_indexed | 2024-03-07T22:26:43Z |
| format | Article |
| id | doaj.art-74fdc3932d894d779070555ccecee463 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-07T22:26:43Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-74fdc3932d894d779070555ccecee4632024-02-23T15:22:13ZengMDPI AGJournal of Clinical Medicine2077-03832024-02-01134107310.3390/jcm13041073Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial FibrillationSteven Deitelzweig0Amiee Kang1Jenny Jiang2Chuan Gao3Xuemei Luo4Nipun Atreja5Stella Han6Dong Cheng7Saarusri R Loganathan8Gregory Y. H. Lip9Ochsner Clinic Foundation, New Orleans, LA 70121, USABristol Myers Squibb, Lawrenceville, NJ 08648, USABristol Myers Squibb, Lawrenceville, NJ 08648, USABristol Myers Squibb, Lawrenceville, NJ 08648, USAPfizer Inc., Groton, CT 06340, USABristol Myers Squibb, Lawrenceville, NJ 08648, USABristol Myers Squibb, Lawrenceville, NJ 08648, USABristol Myers Squibb, Lawrenceville, NJ 08648, USAMu Sigma Business Solutions Pvt. Ltd., Bangalore 560066, IndiaLiverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UKBackground: Real-world evidence on direct oral anticoagulant outcomes among Non-Valvular Atrial Fibrillation (NVAF) patients is limited. We aimed to evaluate stroke/systemic embolism (SE) and major bleeding (MB) risks among NVAF patients continuing or switching to different oral anticoagulants. Methods: Using Optum’s de-identified Clinformatics® Data Mart Database, we identified NVAF patients initiating apixaban or rivaroxaban between 1 January 2013 and 31 December 2021. Patients switching therapies within 30 days before or 90 days after discontinuing their initial DOAC and those who continued initial therapy were included. The index date was the switch date for switchers, while continuers were assigned a hypothetic index date. Switchers and continuers were propensity score matched based on pre-index characteristics. Results: Among 167,868 apixaban and 65,888 rivaroxaban initiators, 2900 apixaban-to-rivaroxaban switchers were matched with 14,500 apixaban continuers, and 2873 rivaroxaban-to-apixaban switchers were matched with 14,365 rivaroxaban continuers. Apixaban-to-rivaroxaban switching was associated with higher stroke/SE risk (HR: 1.99, 95% CI: 1.38–2.88) and MB risk (HR:1.80, 95% CI: 1.46–2.23) than continuing apixaban. Rivaroxaban-to-apixaban switching had similar stroke/SE risk (HR: 0.74, 95% CI: 0.45–1.22) but lower MB risk (HR: 0.49, 95% CI: 0.38–0.65) than continuing rivaroxaban. Conclusions: These findings may aid physicians and patients in making informed decisions when considering a switch between apixaban and rivaroxaban.https://www.mdpi.com/2077-0383/13/4/1073direct oral anticoagulantsnon-valvular atrial fibrillationreal worldstrokemajor bleedingswitching |
| spellingShingle | Steven Deitelzweig Amiee Kang Jenny Jiang Chuan Gao Xuemei Luo Nipun Atreja Stella Han Dong Cheng Saarusri R Loganathan Gregory Y. H. Lip Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation Journal of Clinical Medicine direct oral anticoagulants non-valvular atrial fibrillation real world stroke major bleeding switching |
| title | Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation |
| title_full | Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation |
| title_fullStr | Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation |
| title_full_unstemmed | Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation |
| title_short | Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation |
| title_sort | clinical impact of switching or continuation of apixaban or rivaroxaban among patients with non valvular atrial fibrillation |
| topic | direct oral anticoagulants non-valvular atrial fibrillation real world stroke major bleeding switching |
| url | https://www.mdpi.com/2077-0383/13/4/1073 |
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