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Costa OS, Beyer-Westendorf J, Ashton V, Milentijevic D, Moore KT, Bunz TJ, Coleman CI. Rivaroxaban Versus Warfarin for Management of Obese African Americans With Non-Valvular Atrial Fibrillation or Venous Thromboembolism: A Retrospective Cohort Analysis. Clin Appl Thromb Hemost 2020; 26:1076029620954910. [PMID: 33085526 PMCID: PMC7588768 DOI: 10.1177/1076029620954910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
African Americans (AAs) and obese individuals have increased thrombotic risk.
This study evaluated the effectiveness and safety of rivaroxaban versus warfarin
in obese, AAs with nonvalvular atrial fibrillation (NVAF) or venous
thromboembolism (VTE). Optum® De-Identified Electronic Health Record (EHR) data
was used to perform separate propensity-score matched analyses of adult, oral
anticoagulant (OAC)-naïve AAs with NVAF or acute VTE, respectively; who had a
body mass index≥30kg/m2 and ≥12-months EHR activity with ≥1-encounter
before OAC initiation. Cox regression was performed and reported as hazard
ratios (HRs) with 95% confidence intervals (CIs). For the NVAF analysis, 1,969
rivaroxaban- and 1,969 warfarin-users were matched. Rivaroxaban was not
associated with a difference in stroke/systemic embolism versus warfarin (HR =
0.88, 95%CI = 0.60-1.28), but less major bleeding (HR = 0.68, 95%CI = 0.50-0.94)
was observed. Among 683 rivaroxaban-users with VTE, 1:1 matched to
warfarin-users, rivaroxaban did not alter recurrent VTE (HR = 1.36, 95%CI =
0.79-2.34) or major bleeding (HR = 0.80, 95%CI = 0.37-1.71) risk versus warfarin
at 6-months (similar findings observed at 3- and 12-months). Rivaroxaban
appeared to be associated with similar thrombotic, and similar or lower major
bleeding risk versus warfarin in these obese, AA cohorts.
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Affiliation(s)
- Olivia S Costa
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA.,Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA
| | - Jan Beyer-Westendorf
- Thrombosis Unit, University Hospital "Carl Gustav Carus", Technical University Dresden, Dresden, Germany
| | | | | | | | | | - Craig I Coleman
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA.,Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA
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