Effectiveness and safety of low-dose versus standard-dose rivaroxaban and apixaban in patients with atrial fibrillation - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue PLoS ONE Année : 2022

Effectiveness and safety of low-dose versus standard-dose rivaroxaban and apixaban in patients with atrial fibrillation

, , , , (1, 2) ,
1
2
Sylvie Perreault
Robert Côté
  • Fonction : Auteur
Alice Dragomir
  • Fonction : Auteur
Brian White-Guay
  • Fonction : Auteur
Marc Dorais
  • Fonction : Auteur

Résumé

Background Low-dose direct oral anticoagulant (DOAC) use is quite prevalent in clinical practice, but evidence of its effectiveness and safety compared with high-dose DOAC in patients with atrial fibrillation (AF) remains limited. We aimed to assess the effectiveness and safety of low-dose and high-dose DOACs in patients with AF with similar baseline characteristics. Methods We used a cohort of hospitalized patients with a primary or secondary diagnosis of AF after discharge to the community, whose data were stored in the Quebec administrative databases, from 2011 to 2017. Older adults with AF newly prescribed with rivaroxaban (15 or 20 mg) or apixaban (2.5 mg or 5 mg) were classified as under treatment (UT) and intent to treat (ITT). We used an inverse probability treatment weighting study of new users of rivaroxaban and apixaban to address confounding by indication. The primary effectiveness outcome was ischemic stroke/systemic embolism (SE), while the primary safety outcome was major bleeding (MB). We used Cox proportional models to estimate the marginal hazard ratios (HRs). Findings A total of 1,722 and 4,639 patients used low-dose and standard-dose rivaroxaban, respectively, while 3,833 and 6,773 patients used low-dose and standard-dose apixaban, respectively. No significant difference was observed in the incidence of comparative stroke/SE and MB between low-dose and standard-dose rivaroxaban, except for the risk of acute myocardial infarction (AMI), which was increased with the low dose in the UT analysis. For apixaban, no difference was found in the bleeding rates, but the risk of stroke/SE (HR: 1.95; 95% confidence interval (CI): 1.38–2.76) and death (HR: 1.99; 95% CI: 1.46–2.70) were greater in the low-dose group than in the standard-dose group in the UT analysis. Similar results were observed for the ITT analysis. Conclusion No significant differences were observed in the effectiveness or safety outcome between low-dose and standard-dose rivaroxaban, except for AMI. However, low-dose apixaban was associated with a greater risk of stroke/SE and death without a reduction in the bleeding rates.

Dates et versions

hal-03890259 , version 1 (08-12-2022)

Identifiants

Citer

Sylvie Perreault, Robert Côté, Alice Dragomir, Brian White-Guay, Aurélie Lenglet, et al.. Effectiveness and safety of low-dose versus standard-dose rivaroxaban and apixaban in patients with atrial fibrillation. PLoS ONE, 2022, 17 (12), pp.e0277744. ⟨10.1371/journal.pone.0277744⟩. ⟨hal-03890259⟩

Collections

U-PICARDIE MP3CV
0 Consultations
0 Téléchargements

Altmetric

Partager

Gmail Facebook Twitter LinkedIn More