Abstract 9301: Comparative Effectiveness and Safety of Direct Oral Anticoagulants versus Warfarin in Patients With Chronic Kidney Disease Stage III and Atrial Fibrillation

Abstract

Introduction: The effectiveness and safety of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with stage III chronic kidney disease (CKD) is still questioned. This study assessed the comparative effectiveness and safety of DOACs vs warfarin in stage III CKD AF patients. Methods: A cohort of patients with inpatient or outpatient coding for AF who were newly prescribed an oral anticoagulant (OAC) was created using Quebec provincial administrative databases from 2011-2017. The primary effectiveness outcome was a composite of ischemic stroke, systemic embolism and death and the primary safety outcome was a composite of intracranial, gastrointestinal and major bleeding from other sites in the first year after OAC initiation. Treatment groups were compared using inverse-probability-of-treatment-weighting Cox proportional-hazards models at under-treatment analysis. Results: 14,200 qualifying patients filled a claim for a new OAC prescription; 7,592 for warfarin 1,110 for rivaroxaban 20 mg, 2,084 for apixaban 5 mg and 1,674 for apixaban 2.5 mg. Rivaroxaban 20 mg was associated with a similar composite effectiveness (hazard ratio [HR] 0.84; 95% confidence intervals [CI] 0.62-1.12) and composite safety risk (HR 1.09; 95% CI 0.74-1.62) compared to warfarin (Figure 1). Apixaban 5 mg was associated with a lower composite effectiveness (HR 0.68; 95% CI 0.53-0.86), but similar composite safety risk (HR 0.89; 95% CI 0.64-1.22), whereas apixaban 2.5 mg was associated with a similar composite effectiveness (HR 0.97; 95% CI 0.78-1.21), but lower composite safety risk (HR 0.56; 95% CI 0.37-0.85). Conclusions: In comparison to warfarin, rivaroxaban and apixaban appear to be effective and safe in stage III CKD patients with AF.