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Al-Maqbali JS, Alawi AMA, Al-Adawi M, Al-Falahi Z, Al-Azizi A, Al Badi K, Rawahi MA. Clinical Associations with the differences in rivaroxaban dosing in patients with atrial fibrillation stratified by three renal function formulae. Pharm Pract (Granada) 2023; 21:2758. [PMID: 37090449 PMCID: PMC10117315 DOI: 10.18549/pharmpract.2023.1.2758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/12/2022] [Indexed: 04/08/2023] Open
Abstract
Background Clinical trials used Cockcroft-Gault (CG) formula to calculate the estimated glomerular filtration rate (eGFR) in order to dose rivaroxaban for patients with atrial fibrillation (AF). Objectives The aim of this study is to evaluate rivaroxaban dosing appropriateness in patients with AF with or without renal impairment based on the CG formula and other formulae, including Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the isotope dilution mass spectrometry (IDMS) traceable Modification of Diet in Renal Disease (MDRD) Study equation and the associated clinical outcomes. Methodology A retrospective cohort study conducted at Sultan Qaboos University Hospital (SQUH) from 1st January 2016 to 31st December 2020, included all adult patients (≥ 18 years) treated with rivaroxaban for AF and followed up for one year after starting the treatment. Results Based on the CG formula, the rivaroxaban dose was inappropriately prescribed in 27% of the patients (21% overdosed and 6% underdosed). Higher baseline creatinine (P=0.0014) and concurrent use of antiplatelet therapy (P<0.001) were associated with the tendency to rivaroxaban overdosing. Higher Body Mass Index (BMI) (P=0.002), female sex (P=0.032), and CKD (P=0.003) were associated with rivaroxaban underdosing. The degree of agreement between the renal function tests when comparing MDRD vs CG and CKD-EPI vs CG in terms of estimated glomerular filtration rate/creatine clearance (eGFR/CrCl) calculation was moderate (κ=0.46) and poor (κ=0.00), respectively, while, in terms of rivaroxaban dose appropriateness was almost perfect (κ=0.82) and substantial (κ=0.77). Clinical outcomes measured by stroke and bleeding events were not significantly different according to the appropriateness of the rivaroxaban dose. Conclusion This study has shown a relatively high consistency with the gold standard in dosing rivaroxaban in AF patients using CG formula. Treatment efficiency and safety were not affected by the proportion of dose inappropriateness found in this cohort.
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Affiliation(s)
| | - Abdullah M Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Oman Medical Specialty Board, Muscat, Oman.
| | | | - Zubaida Al-Falahi
- Department of Medicine, Sultan Qaboos University Hospital, Oman Medical Specialty Board, Muscat, Oman.
| | - Asia Al-Azizi
- Pharmacutical care and medical Store Department, Samail Hospital, Samail, Oman.
| | - Kholoud Al Badi
- Department of Pharmacy, Diwan of the Royal Court Polyclinic, Muscat, Oman.
| | - Mohamed Al Rawahi
- Department of Medicine, Sultan Qaboos University Hospital, Oman Medical Specialty Board, National Heart Center, The Royal Hospital, Muscat, Oman.
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Marin F, Fernández MS, Lekuona I, Arribas F, Barón-Esquivias G, Barrios V, Cosin-Sales J, Freixa-Pamias R, Masjuan J, Pérez-Cabeza AI, Schilling VR, Vázquez Rodríguez JM, Priu CR, Sánchez MA. Rivaroxaban for the prevention of outcomes in patients with atrial fibrillation in clinical practice: an indirect comparison of national and international registries. J Comp Eff Res 2022; 11:1173-1184. [PMID: 36148923 DOI: 10.2217/cer-2022-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To analyze the effectiveness and safety of rivaroxaban in patients with atrial fibrillation (AF). Methods: The clinical profile and outcomes of the EMIR study were indirectly compared with those of ROCKET-AF, eight other Spanish observational studies and XANTUS. Results: In EMIR, mean age was 74.2 years and CHA2DS2-VASc was 3.5. In the rivaroxaban arm of the ROCKET-AF trial, mean age was 73 years and CHADS2 was 3.5, whereas in the Spanish studies mean age ranged from 74.9 years to 78.4 years and CHA2DS2-VASc from 3.5 to 4.3. In EMIR, rates of stroke/systemic embolism, major adverse cardiovascular events, cardiovascular death and major bleeding were 0.57, 1.07, 0.63 and 1.04 events/100 patient-years, respectively. In ROCKET-AF, these numbers were 1.7, 3.91, 1.53 and 3.6 events/100 patient-years, respectively. In the Spanish studies, rates of stroke and major bleeding were 0-1.8 and 0.22-4.2 events/100 patient-years, respectively. In XANTUS, rates of stroke, major adverse cardiovascular events and major bleeding were 0.7, 1.8 and 2.1 events/100 patient-years, respectively. Conclusion: Despite the fact that rivaroxaban is prescribed for elderly patients with a high thromboembolic risk, rates of outcomes remain low.
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Affiliation(s)
- Francisco Marin
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
| | | | - Iñaki Lekuona
- Department of Cardiology, Hospital Galdakao-Usansolo, Bizkaia, Spain
| | - Fernando Arribas
- Department of Cardiology, Hospital Universitario 12 de Octubre; Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid (UCM); Instituto de Investigacion Sanitaria Hospital 12 de Octubre (imas12); CIBERCV, Madrid, Spain
| | - Gonzalo Barón-Esquivias
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain; Unidad Cardiovascular, Instituto de Biotecnología de Sevilla; Centro de Investigación en Red Cardiovascular, Madrid, Spain
| | - Vivencio Barrios
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid; Alcalá University, Madrid, Spain
| | - Juan Cosin-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Román Freixa-Pamias
- Department of Cardiology, Hospital Universitari Complex Moisès Broggi, Barcelona, Spain
| | - Jaime Masjuan
- Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, Departamento de Medicina, Universidad de Alcalá. Red INVICTUS, Madrid, Spain
| | | | - Vanessa Roldán Schilling
- Department of Haematology & Clinical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, Murcia, Spain
| | | | | | - Manuel Anguita Sánchez
- Department of Cardiology, Hospital Reina Sofía Córdoba, IMIBIC, University of Cordoba, Córdoba, Spain
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Fernández MS, Marín F, Rafols C, Arribas F, Barrios V, Cosín-Sales J, Sánchez MA. Thromboembolic and bleeding events with rivaroxaban in clinical practice in Spain: impact of inappropriate doses (the EMIR study). J Comp Eff Res 2021; 10:583-593. [PMID: 33787316 DOI: 10.2217/cer-2020-0286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: To analyze the frequency and variables related to inappropriate rivaroxaban dosage in clinical practice and its impact on outcomes after 2 years. Materials & methods: Postauthorization, observational, multicenter study, in which atrial fibrillation patients, treated with rivaroxaban ≥6 months were included. Results: A total of 1421 patients (74.2 ± 9.7 years, CHA2DS2-VASc 3.5 ± 1.6) were included. Overall, 22.9% received rivaroxaban 15 mg. The proper dose of rivaroxaban was taken by 83.3% (9.7% underdosed, 7.0% overdosed). Older age and renal insufficiency were associated with inadequate rivaroxaban dosage. There was a trend toward higher all-cause mortality among underdosed patients (adjusted hazard ratio 1.39; 95% CI 0.75-2.58), and more bleedings in overdosed patients (2.29 vs 0.80 events/100 patient-years; p = 0.14). Conclusion: In clinical practice, rivaroxaban is properly dosed in most patients.
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Affiliation(s)
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
| | - Carles Rafols
- Department of Medical Affairs, Bayer Hispania, Barcelona, Spain
| | - Fernando Arribas
- Department of Cardiology, Hospital Universitario 12 de Octubre; Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid (UCM); Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12); CIBERCV, Madrid, Spain
| | - Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal; Alcalá University, Madrid, Spain
| | - Juan Cosín-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Manuel Anguita Sánchez
- Department of Cardiology, Hospital Universitario Reina Sofia, IMIBIC, University of Córdoba, Córdoba, Spain
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Anguita M, de la Figuera M, Cabeza AIP, Fernández CS. Clinical profile and management of rivaroxaban in patients with atrial fibrillation in routine practice in Spain: data from six nationwide studies. Drugs Context 2019; 8:212606. [PMID: 31692949 PMCID: PMC6822684 DOI: 10.7573/dic.212606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022] Open
Abstract
AIMS To analyze the clinical profile and management of patients with nonvalvular atrial fibrillation taking rivaroxaban in routine practice in Spain. METHODS Clinical data from the observational studies HEROIC (cardiology and hematology; n=1,727), EMIR (cardiology; n=1,493), BRONCE-AP (primary care; n=133), SILVER-AP (primary care; n=457), ALADIN (internal medicine and neurology; n=249), and ESPARTA (internal medicine; n=110) of patients taking rivaroxaban were analyzed. The clinical profile was compared with those of the XANTUS and ROCKET-AF studies. RESULTS Overall, mean age was 74.9±9.4 years, CHA2DS2-VASc score was 3.7±1.5, and 43.2% had a HAS-BLED score ≥3. Patients included in the HEROIC and EMIR studies were older and more frequently had a creatinine clearance <50 mL/min and a higher thromboembolic risk than those in the XANTUS study, and patients included in the ALADIN study were older and had more prior cerebrovascular disease, but a lower thromboembolic risk than those in the ROCKET-AF trial. In those studies with available data, medication adherence and satisfaction with rivaroxaban were high. CONCLUSION Bearing in mind differences according to the clinical setting of each study, atrial fibrillation patients taking rivaroxaban in Spain were elderly and had a high thromboembolic risk. Medication adherence and satisfaction with rivaroxaban were high.
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Affiliation(s)
- Manuel Anguita
- Cardiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | | | | | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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5
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Escobar C, Martí-Almor J, Pérez Cabeza A, Martínez-Zapata MJ. Anticoagulantes orales directos frente a antagonistas de la vitamina K en pacientes con fibrilación auricular de la práctica clínica: revisión sistemática y metanálisis. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.02.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Cerdá M, Cerezo-Manchado JJ, Johansson E, Martínez F, Fernández M, Varela A, Rodríguez S, Bosch F, Santamaría A. Facing real-life with direct oral anticoagulants in patients with nonvalvular atrial fibrillation: outcomes from the first observational and prospective study in a Spanish population. J Comp Eff Res 2019; 8:165-178. [DOI: 10.2217/cer-2018-0134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: To analyze the effectiveness and safety of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients attended in clinical practice. Methods: Observational and prospective study of AF patients that started treatment with DOACs. Results: 1443 patients (age 77.2 ± 9.7 years, CHA2DS2-VASc = 4.1 ± 1.5) were included. 46.0% were taking rivaroxaban, 24.4% dabigatran, 22.5% apixaban and 7.1% edoxaban. Patients taking dabigatran were younger, had lower CHA2DS2-VASc and lesser renal insufficiency. Patients taking apixaban had higher CHA2DS2-VASc and more renal insufficiency. Rates of stroke/major bleeding/intracranial bleeding were 0.7/1.3/0.2 events/100 patient-years, respectively. Conclusion: This was the first prospective study that analyzed the use of all DOACs in AF patients in Spain, showing a good profile in terms of safety and effectiveness in accordance with pivotal studies.
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Affiliation(s)
- María Cerdá
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Erik Johansson
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Ana Varela
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
| | - Saray Rodríguez
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
| | - Francesc Bosch
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
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Pimentel Quezada Y, Bonilla Palomas JL, Gámez López AL, Moreno Conde M, López Ibáñez MC, Gallego de la Sacristana López-Serrano Á. Has the clinical profile of patients with nonvalvular atrial fibrillation treated with rivaroxaban changed in the last 5 years of use? Future Cardiol 2018; 14:47-53. [PMID: 29848089 DOI: 10.2217/fca-2018-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To analyze the evolution of clinical profile of patients with nonvalvular atrial fibrillation treated with rivaroxaban. METHODS Retrospective study in which patients treated with rivaroxaban were divided into two groups according to the data in which the initial prescription was performed (November 2012-December 2013 and January 2014-January 2017). RESULTS 211 patients (mean age 76.7 ± 9.2 years; CHA2DS2-VASc 3.8 ± 1.5; HAS-BLED 2.0 ± 0.8.) were included. Age and bleeding risk were higher in those subjects in which the prescription started earlier. Rates of stroke/TIA, major bleeding and intracranial hemorrhage were 2.3/4.2/0.6 events/100 patient-years, respectively. CONCLUSION Although, the initial prescription of rivaroxaban was mainly performed in very elderly patients and/or with a higher bleeding risk, this has been extended to the overall nonvalvular atrial fibrillation population.
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Affiliation(s)
- Yesenia Pimentel Quezada
- Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda (Jaén), Spain
| | - Juan Luis Bonilla Palomas
- Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda (Jaén), Spain
| | - Antonio Luis Gámez López
- Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda (Jaén), Spain
| | - Mirian Moreno Conde
- Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda (Jaén), Spain
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8
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Cerezo-Manchado JJ, Navarro-Almenzar B, Elvira-Ruiz G, García-Candel F, Flores-Blanco PJ, Caro-Martínez C, Manzano-Fernández S, García-Iniesta N, Sánchez-García J, Cabañas-Perianes V, Moraleda-Jiménez J. Effectiveness and safety of rivaroxaban in a cohort of 142 patients with nonvalvular atrial fibrillation treated with rivaroxaban for the prevention of stroke. Future Cardiol 2018; 14:31-37. [DOI: 10.2217/fca-2018-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: To evaluate the clinical profile and effectiveness/safety of patients taking rivaroxaban in clinical practice. Methods: Retrospective study that included patients with nonvalvular atrial fibrillation treated with rivaroxaban for the prevention of stroke between January 2012 and December 2016 in a tertiary hospital in Spain. Results: A total of 142 patients (median age 78 years, 40.1% men, 32.4% creatinine clearance <50 ml/min; 96.5% CHA2DS2-VASc ≥2; 44.3% HAS-BLED ≥3) were included. Only two patients had a thromboembolic event (in both cases ischemic stroke) and three patients had major bleeding (rates of 1.3 and 1.9 events/100 patient years, respectively). Conclusion: Data regarding effectiveness and safety in our cohort were consistent with previous studies, showing that rivaroxaban can be effective and safely used in our setting.
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Affiliation(s)
- Juan José Cerezo-Manchado
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Begoña Navarro-Almenzar
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ginés Elvira-Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Faustino García-Candel
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | - Natalia García-Iniesta
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Javier Sánchez-García
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Valentín Cabañas-Perianes
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Lobato SM, Tarrazo CT, Fernández EG, Alcalá MM. Clinical profile, adequacy of dosage and thromboembolic and bleeding outcomes in patients with nonvalvular atrial fibrillation treated with rivaroxaban in a regional hospital of Asturias, Spain. Future Cardiol 2018; 14:17-24. [DOI: 10.2217/fca-2018-0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aim: To analyze the clinical profile and outcomes of patients with nonvalvular atrial fibrillation treated with rivaroxaban in a regional hospital. Methods: Retrospective study of patients with nonvalvular atrial fibrillation that started treatment with rivaroxaban between July 2013 and May 2017 in a regional hospital. Results: 189 patients (age 76.0 ± 9.4 years; CHA2DS2-VASc 4.1 ± 1.7; HAS-BLED 2.1 ± 0.9) were included. Rivaroxaban 20 mg was taken by 74.1% of patients. Among patients treated with rivaroxaban 20 and 15 mg, only 3.6 and 22.5%, respectively, received an inadequate dose. After 26.6 ± 11.6 months of treatment, annual discontinuation rate was 1%. Rates of stroke, major bleeding and intracranial hemorrhage were 0.45, 0.22 and 0.22 events/100 patient years, respectively. Conclusion: In our practice of regional hospital, rates of discontinuation, thromboembolic and bleeding outcomes are low.
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Affiliation(s)
- Sara Muñiz Lobato
- Servicio Hematología y Hemoterapia, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - Marlén Morán Alcalá
- Servicio Hematología y Hemoterapia, Hospital Universitario San Agustín, Avilés, Spain
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10
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Martí E, Segado A, Pastor-Galán I, Amat P, Remigia MJ, Solano C, Navarro B. Use of rivaroxaban for the prevention of stroke in patients with nonvalvular atrial fibrillation in Spain. Future Cardiol 2018; 14:3-8. [DOI: 10.2217/fca-2018-0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To analyze the clinical profile and rates of stroke, major bleeding and intracranial hemorrhage of patients with atrial fibrillation (AF) treated with rivaroxaban in clinical practice. Methods: Retrospective study of AF patients anticoagulated with rivaroxaban in a Healthcare Area of Valencia, Spain. Patients started treatment with rivaroxaban from July 2012 to December 2015. Results: A total of 230 patients (mean age 76.9 ± 9.9 years; CHA2DS2-VASc 4.3 ± 1.7; HAS-BLED 1.7 ± 0.9) were included. Rates of stroke, major bleeding and intracranial bleeding were 0.4, 1.9 and 0.5 events per 100 patient-years, respectively. Conclusion: In this cohort of AF patients anticoagulated with rivaroxaban, despite patients being older and having a high thromboembolic risk, rates of stroke, major bleeding and intracranial bleeding were low.
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Affiliation(s)
- Edelmira Martí
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Valencia, Spain
| | - Alejandra Segado
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Valencia, Spain
| | - Irene Pastor-Galán
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Valencia, Spain
| | - Paula Amat
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Valencia, Spain
| | - Maria José Remigia
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Valencia, Spain
| | - Carlos Solano
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Blanca Navarro
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Valencia, Spain
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11
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Escobar C, Martí-Almor J, Pérez Cabeza A, Martínez-Zapata MJ. Direct Oral Anticoagulants Versus Vitamin K Antagonists in Real-life Patients With Atrial Fibrillation. A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2018; 72:305-316. [PMID: 29606361 DOI: 10.1016/j.rec.2018.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/02/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To assess the effectiveness of direct oral anticoagulants vs vitamin K antagonists in real-life patients with atrial fibrillation. METHODS A systematic review was performed according to Cochrane methodological standards. The results were reported according to the PRISMA statement. The ROBINS-I tool was used to assess risk of bias. RESULTS A total of 27 different studies publishing data in 30 publications were included. In the studies with a follow-up up to 1 year, apixaban (HR, 0.93; 95%CI, 0.71-1.20) and dabigatran (HR, 0.95; 95%CI, 0.80-1.13) did not significantly reduce the risk of ischemic stroke vs warfarin, whereas rivaroxaban significantly reduced this risk (HR, 0.83; 95%CI, 0.73-0.94). Apixaban (HR, 0.66; 95%CI, 0.55-0.80) and dabigatran (HR, 0.83; 95%CI, 0.70-0.97) significantly reduced the major bleeding risk vs warfarin, but not rivaroxaban (HR, 1.02; 95%CI, 0.95-1.10), although with a high statistical heterogeneity among studies. Apixaban (HR, 0.56; 95%CI, 0.42-0.73), dabigatran (HR, 0.45; 95%CI, 0.39-0.51), and rivaroxaban (HR, 0.66; 95%CI, 0.49-0.88) significantly reduced the risk of intracranial bleeding vs warfarin. Reduced doses of direct oral anticoagulants were associated with a slightly better safety profile, but with a marked reduction in stroke prevention effectiveness. CONCLUSIONS Data from this meta-analysis suggest that, vs warfarin, the stroke prevention effectiveness and bleeding risk of direct oral anticoagulants may differ in real-life patients with atrial fibrillation.
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Affiliation(s)
- Carlos Escobar
- Departamento de Cardiología, Hospital La Paz, Madrid, Spain.
| | | | | | - M José Martínez-Zapata
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain
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