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OR SWITCHERS FROM WARFARIN
662 JACC April 5, 2016 Volume 67, Issue 13
Arrhythmias and Clinical EP REAL-WORLD COMPARISON OF INPATIENT BLEEDING RISK, BLEEDING-RELATED HOSPITALIZATION RATES AND COSTS AMONG NON-VALVULAR ATRIAL FIBRILLATION PATIENTS ON APIXABAN, DABIGATRAN, RIVAROXABAN: COHORTS COMPRISING NEW INITIATORS AND/OR SWITCHERS FROM WARFARIN Moderated Poster Contributions Arrhythmias and Clinical EP Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:10 a.m. Session Title: Anticoagulation and Stroke Prevention in AF: The Good, the Bad, and the Ugly Abstract Category: 21. Arrhythmias and Clinical EP: VT Presentation Number: 1130M-01 Authors: Ping Tepper, Jack Mardekian, Cristina Masseria, Ruslan Horblyuk, Shital Kamble, Melissa Hamilton, Younos Abdulsattar, William Petkun, Gregory Y. H. Lip, Pfizer Inc., NYC, NY, USA
Background: Information about the risk of bleeding and bleeding-related resource use and costs among non-Vitamin K antagonist oral anticoagulants (NOACs) in the real-world setting is scarce. This study aim was to compare inpatient bleeding risks, bleeding-related hospitalization rates and costs among non-valvular atrial fibrillation (NVAF) patients treated with apixaban vs. dabigatran or rivaroxaban in a large US database.
Methods: NVAF patients ≥18 years who initiated NOAC or switched to NOAC from warfarin between 01/01/2013 and 31/10/2014 were identified in the MarketScan Earlyview insurance claims database. Patients were followed up to 6 months until bleeding, discontinuation/ switch of therapy, disenrollment or study end. Hazard ratios (HRs) of inpatient bleeding for rivaroxaban or dabigatran vs. apixaban were estimated using multivariate Cox regression. Per patient per month (PPPM) bleeding-related hospitalization rates and PPPM costs over 6 months of follow up or until disenrollment or study end were compared using two-part Poisson and generalized linear models, respectively. Results: Apixaban prescribed NVAF patients (n=8,785) were more likely to have switched from warfarin, receive antiplatelet agents, have more comorbidities, and higher CHA2DS2-VASc and HAS-BLED scores as compared to dabigatran (n=20,963) or rivaroxaban (n=30,529) patients. Compared to apixaban, use of rivaroxaban was associated with significantly higher risk of inpatient bleeding (adjusted HR= 1.52; 95% CI: 1.26-1.83). After adjustment, PPPM bleeding-related hospitalization rate (0.010 vs. 0.006, p<0.001) and PPPM inpatient bleedingrelated costs ($283 vs. $185, p<0.001) were significantly higher for rivaroxaban compared to apixaban . No differences in outcomes of interest were observed between dabigatran and apixaban.
Conclusions: In this real-world data analysis of NVAF patients followed for up to 6 months after treatment initiation, use of rivaroxaban was associated with an increased risk of inpatient bleeding, significantly higher PPPM bleeding-related hospitalization rate and associated costs compared to apixaban.
Arrhythmias and Clinical EP REAL-WORLD COMPARISON OF INPATIENT BLEEDING RISK, BLEEDING-RELATED HOSPITALIZATION RATES AND COSTS AMONG NON-VALVULAR ATRIAL FIBRILLATION PATIENTS ON APIXABAN, DABIGATRAN, RIVAROXABAN: COHORTS COMPRISING NEW INITIATORS AND/OR SWITCHERS FROM WARFARIN Moderated Poster Contributions Arrhythmias and Clinical EP Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:10 a.m. Session Title: Anticoagulation and Stroke Prevention in AF: The Good, the Bad, and the Ugly Abstract Category: 21. Arrhythmias and Clinical EP: VT Presentation Number: 1130M-01 Authors: Ping Tepper, Jack Mardekian, Cristina Masseria, Ruslan Horblyuk, Shital Kamble, Melissa Hamilton, Younos Abdulsattar, William Petkun, Gregory Y. H. Lip, Pfizer Inc., NYC, NY, USA
Background: Information about the risk of bleeding and bleeding-related resource use and costs among non-Vitamin K antagonist oral anticoagulants (NOACs) in the real-world setting is scarce. This study aim was to compare inpatient bleeding risks, bleeding-related hospitalization rates and costs among non-valvular atrial fibrillation (NVAF) patients treated with apixaban vs. dabigatran or rivaroxaban in a large US database.
Methods: NVAF patients ≥18 years who initiated NOAC or switched to NOAC from warfarin between 01/01/2013 and 31/10/2014 were identified in the MarketScan Earlyview insurance claims database. Patients were followed up to 6 months until bleeding, discontinuation/ switch of therapy, disenrollment or study end. Hazard ratios (HRs) of inpatient bleeding for rivaroxaban or dabigatran vs. apixaban were estimated using multivariate Cox regression. Per patient per month (PPPM) bleeding-related hospitalization rates and PPPM costs over 6 months of follow up or until disenrollment or study end were compared using two-part Poisson and generalized linear models, respectively. Results: Apixaban prescribed NVAF patients (n=8,785) were more likely to have switched from warfarin, receive antiplatelet agents, have more comorbidities, and higher CHA2DS2-VASc and HAS-BLED scores as compared to dabigatran (n=20,963) or rivaroxaban (n=30,529) patients. Compared to apixaban, use of rivaroxaban was associated with significantly higher risk of inpatient bleeding (adjusted HR= 1.52; 95% CI: 1.26-1.83). After adjustment, PPPM bleeding-related hospitalization rate (0.010 vs. 0.006, p<0.001) and PPPM inpatient bleedingrelated costs ($283 vs. $185, p<0.001) were significantly higher for rivaroxaban compared to apixaban . No differences in outcomes of interest were observed between dabigatran and apixaban.
Conclusions: In this real-world data analysis of NVAF patients followed for up to 6 months after treatment initiation, use of rivaroxaban was associated with an increased risk of inpatient bleeding, significantly higher PPPM bleeding-related hospitalization rate and associated costs compared to apixaban.