Kidney, limb and ophthalmic complications and death in patients with nonvalvular atrial fibrillation and type 2 diabetes prescribed rivaroxaban or warfarin: an electronic health record analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Bayer AG, Berlin, Germany INTRODUCTION Patients with nonvalvular atrial fibrillation (NVAF) and type 2 diabetes (T2D) have a higher risk of kidney, limb, and ophthalmic complications than those without T2D. PURPOSE We sought to evaluate these complications and death in patients with NVAF and T2D prescribed rivaroxaban or warfarin. METHODS We analyzed Optum® de-Identified electronic health record (EHR) data from 11/2010-12/2019. We included adults with NVAF and T2D newly initiated on rivaroxaban or warfarin with ≥12 months of prior EHR activity. Patients with another indication for anticoagulation, valve disease, history of end-stage renal disease, major adverse limb events (MALE), diabetic retinopathy or pregnancy were excluded. We evaluated the incidence rate of developing a composite outcome of >40% decrease in estimated glomerular filtration incidence rate (eGFR) from baseline, eGFR < 15 mL/minute/1.73 m2, need for dialysis or kidney transplant, MALE, diabetic retinopathy or death. Overlap weighting was used to balance baseline characteristics between cohorts while preserving sample size. Hazard ratios with 95% confidence intervals were calculated using propensity score-overlap weighted Cox regression. RESULTS We included 24912 rivaroxaban and 58270 warfarin users. Rivaroxaban was associated with a significant reduction in the composite endpoint versus warfarin (-19.7 events per 1000 person years) driven mostly by an >40% decrease in eGFR from baseline, need for dialysis or renal transplant, MALE and death (Figure 1). CONCLUSIONS Rivaroxaban was associated with reduced incidence rates of kidney and limb complications, and death in NVAF patients with T2D. FUNDING Funding for this study was provided by Bayer AG, Berlin, Germany Abstract Figure 1. Outcomes