Patient frailty among patients with non-valvular atrial fibrillation (NVAF) is associated with adverse health outcomes and increased risk of mortality. Additional evidence is needed to evaluate effective and safe NVAF treatment in this patient population.
This subgroup analysis of the ARISTOPHANES study compared the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) among frail NVAF patients prescribed non-vitamin K antagonist oral anticoagulants (NOACs) or warfarin.
This comparative retrospective observational study of frail, older NVAF patients who initiated apixaban, dabigatran, rivaroxaban, or warfarin from 01JAN2013-30SEP2015 was conducted using Medicare and 3 US commercial claims databases. To compare each drug, 6 propensity-score-matched (PSM) cohorts were created. Patient cohorts were pooled from 4 databases after PSM. Cox models were used to estimate hazard ratios (HR) of S/SE and MB.
Among NVAF patients, 34% (N=150,487) met frailty criteria. Apixaban and rivaroxaban were associated with a lower risk of S/SE vs warfarin (apixaban: HR: 0.61, 95% CI: 0.55-0.69; rivaroxaban: HR: 0.79, 95% CI: 0.72-0.87). For MB, apixaban (HR: 0.62, 95% CI: 0.57-0.66) and dabigatran (HR: 0.79, 95% CI: 0.70-0.89) were associated with a lower risk and rivaroxaban (HR: 1.14, 95% CI: 1.08-1.21) was associated with a higher risk vs warfarin.
Among this cohort of frail NVAF patients, NOACs were associated with varying rates of stroke/SE and MB compared to warfarin. Due to the lack of real-world data regarding OAC treatment in frail patients, these results may inform clinical practice in the treatment of this patient population.
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Gregory Y H Lip
Allison V Keshishian
Amiee L Kang
Amol D Dhamane
Xuemei Luo
Xiaoyan Li
Neeraja Balachander
Lisa Rosenblatt
Jack Mardekian
Xianying Pan
Manuela Di Fusco
Alessandra B Garcia Reeves
Huseyin Yuce
Steve Deitelzweig
References
PubMed