New findings published online in the Annals of Internal Medicine report reduced adverse events in older atrial fibrillation patients treated with apixaban. The study was conducted by Dae Hyun Kim, M.D., M.P.H., Sc.D., Harvard Medical School in Boston, and colleagues.

Study design:

Medicare beneficiaries with atrial fibrillation were a part of this study. Direct oral anticoagulants like rivaroxaban, dabigatran, and apixaban were compared for outcomes with warfarin. A propensity score matching was done by the researchers while analyzing the outcomes by frailty levels. 

The primary outcome was an ischemic stroke, a composite endpoint of death, or major bleeding.

Results:

Dabigatran and warfarin initiators:

  • Dabigatran initiators: event rate of 63.5 per 1000 persons per year. 

  • Warfarin initiator: event rate of 65.6 per 1000 persons per year.

The hazard ratio, HR was computed as 0.98, 95 % confidence interval, CI 0.92 to 1.05.

HR:

  • Non-frail individuals; 0.81, 95% CI 0.68 to 0.97.

  • For prefrail participants: 0.98, 95% CI 0.90 to 1.08.

  • Frail atrial fibrillation patients: 1.09, 95% CI 0.96 to 1.23.

Rivaroxaban and warfarin initiators:

  • Rivaroxaban initiators: event rate of 77.8 per 1000 persons per year. 

  • Warfarin initiators: event rate of 83.7 per 1000 persons per year.

HR was computed as 0.98, 95 % CI 0.94 to 1.02.

HR:

  • Non-frail individuals; 0.88, 95% CI 0.77 to 0.99.

  • For prefrail participants: 1.04, 95% CI 0.98 to 1.10.

  • Frail atrial fibrillation patients: 0.96, 95% CI 0.89 to 1.04.

Apixaban and warfarin initiators:

  • Apixaban initiators: event rate of 60.1 per 1000 persons per year. 

  • Warfarin initiators: event rate of 92.3 per 1000 persons per year.

HR was computed as 0.68, 95 % CI 0.65 to 0.72.

HR:

  • Non-frail individuals; 0.61, 95% CI 0.52 to 0.71.

  • For prefrail participants: 0.66, 95% CI 0.61 to 0.70.

  • Frail atrial fibrillation patients: 0.73, 95% CI 0.67 to 0.80.

Across all frailty levels, only apixaban consistently exhibited lower levels of ischemic stroke, a composite endpoint of death and major bleeding.

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Keywords

Disease Condition,Therapeutic Modality,Arrhyhtmias,Pharmacotherapeutics,Atrial Fibrillation,TPHT_others

Source

https://medicalxpress.com/news/2021-07-adverse-events-apixaban-a-fib-older.html