Aims

To compare clinical outcomes of rivaroxaban and warfarin in patients with nonvalvular atrial fibrillation (NVAF) and concurrent obesity and diabetes.

Methods

Patients aged ≥18 years were identified from a healthcare claims database with the following criteria: newly initiating rivaroxaban or warfarin, ≥1 medical claim with a diagnosis of AF, obesity determined by validated machine learning algorithm, and ≥1 claim with a diagnosis of diabetes or for antidiabetic medication. Treatment cohorts were matched using propensity scores and were compared for stroke/systemic embolism (SE) and major bleeding using Cox proportional hazards models.

Results

A total of 9999 matched pairs of NVAF patients with obesity and diabetes who initiated treatment with rivaroxaban or warfarin were included. The composite risk of stroke/SE was significantly lower in the rivaroxaban cohort compared with the warfarin cohort (HR 0.82; 95% CI 0.74–0.90). Risks of ischemic and hemorrhagic strokes were also significantly reduced with rivaroxaban versus warfarin, but not SE. Major bleeding risk was similar between treatment cohorts (HR 0.92; 95% CI 0.78–1.09).

Conclusions

In NVAF patients with comorbidities of obesity and diabetes, rivaroxaban was associated with lower risks of stroke/SE and similar risk of major bleeding versus warfarin.

中文翻译：

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利伐沙班与华法林在合并肥胖和糖尿病的非瓣膜性房颤患者中的有效性和安全性

目标

比较利伐沙班和华法林在非瓣膜性心房颤动 (NVAF) 合并肥胖和糖尿病患者中的临床结果。

方法

根据以下标准从医疗保健索赔数据库中确定年龄≥18 岁的患者：新开始使用利伐沙班或华法林，≥1 次医疗索赔并诊断为 AF，通过验证的机器学习算法确定肥胖，以及≥1 次索赔并诊断为糖尿病或用于抗糖尿病药物。使用倾向评分匹配治疗组，并使用 Cox 比例风险模型比较中风/全身性栓塞 (SE) 和大出血。

结果

共有 9999 对匹配的 NVAF 肥胖和糖尿病患者开始接受利伐沙班或华法林治疗。与华法林组相比，利伐沙班组的卒中/SE 复合风险显着降低（HR 0.82；95% CI 0.74-0.90）。与华法林相比，利伐沙班也显着降低了缺血性和出血性中风的风险，但 SE 没有。治疗组之间的大出血风险相似（HR 0.92；95% CI 0.78–1.09）。

结论

在合并肥胖和糖尿病的 NVAF 患者中，与华法林相比，利伐沙班与较低的卒中/SE 风险和类似的大出血风险相关。