Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort study
Objectives To evaluate the effectiveness and safety of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) among patients with non-valvular atrial fibrillation (NVAF), particularly those with chronic kidney disease (CKD).Design Population-based matched cohort study.Setting O...
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BMJ Publishing Group
2018-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/8/1/e019638.full |
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| author | Samy Suissa James M Brophy Sophie Dell’Aniello Christel Renoux Simone Y Loo Janie Coulombe |
| author_facet | Samy Suissa James M Brophy Sophie Dell’Aniello Christel Renoux Simone Y Loo Janie Coulombe |
| author_sort | Samy Suissa |
| collection | DOAJ |
| description | Objectives To evaluate the effectiveness and safety of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) among patients with non-valvular atrial fibrillation (NVAF), particularly those with chronic kidney disease (CKD).Design Population-based matched cohort study.Setting Over 670 primary care practices in the UK, contributing to the Clinical Practice Research Datalink.Participants Up to 6818 adult patients newly treated with NOACs between 2011 and 2016, matched 1:1 to new users of VKAs on age, sex and high-dimensional propensity score.Interventions Current exposure to NOACs compared with current exposure to VKAs.Main outcome measures HRs of ischaemic stroke and systemic embolism (SE), major bleeding, gastrointestinal (GI) bleeding, intracranial bleeding, myocardial infarction and all-cause mortality.Results In as-treated analyses, the rates of ischaemic stroke/SE were similar between NOACs and VKAs (HR 0.94; 95% CI 0.62 to 1.42), as were the rates of major bleeding (HR 0.86; 95% CI 0.56 to 1.33). NOACs also significantly increased the risk of GI bleeding (HR 1.78; 95% CI 1.27 to 2.48). In patients with NVAF and CKD, NOACs and VKAs remained comparable with respect to the risk of ischaemic stroke/SE (HR 0.79; 95% CI 0.40 to 1.58) and major bleeding (HR 0.88; 95% CI 0.47 to 1.62), with no difference in the risk of GI bleeding (HR 0.99; 95% CI 0.63 to 1.55). Similar results were obtained in on-treatment analyses using a time-dependent exposure definition.Conclusions Our results suggest that in the UK primary care, NOACs are overall effective and safe alternatives to VKAs, among patients with NVAF altogether, as well as in patients with NVAF and CKD. |
| format | Article |
| id | doaj-art-500b1068bf7140daa11dbbe5546efa44 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-500b1068bf7140daa11dbbe5546efa442025-08-20T02:11:26ZengBMJ Publishing GroupBMJ Open2044-60552018-01-018110.1136/bmjopen-2017-019638Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort studySamy Suissa0James M Brophy1Sophie Dell’Aniello2Christel Renoux3Simone Y Loo4Janie Coulombe5Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada1 Center for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada2 Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, CanadaLady Davis Institute for Medical Research Centre for Clinical Epidemiology, Montreal, Québec, Canada1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, CanadaObjectives To evaluate the effectiveness and safety of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) among patients with non-valvular atrial fibrillation (NVAF), particularly those with chronic kidney disease (CKD).Design Population-based matched cohort study.Setting Over 670 primary care practices in the UK, contributing to the Clinical Practice Research Datalink.Participants Up to 6818 adult patients newly treated with NOACs between 2011 and 2016, matched 1:1 to new users of VKAs on age, sex and high-dimensional propensity score.Interventions Current exposure to NOACs compared with current exposure to VKAs.Main outcome measures HRs of ischaemic stroke and systemic embolism (SE), major bleeding, gastrointestinal (GI) bleeding, intracranial bleeding, myocardial infarction and all-cause mortality.Results In as-treated analyses, the rates of ischaemic stroke/SE were similar between NOACs and VKAs (HR 0.94; 95% CI 0.62 to 1.42), as were the rates of major bleeding (HR 0.86; 95% CI 0.56 to 1.33). NOACs also significantly increased the risk of GI bleeding (HR 1.78; 95% CI 1.27 to 2.48). In patients with NVAF and CKD, NOACs and VKAs remained comparable with respect to the risk of ischaemic stroke/SE (HR 0.79; 95% CI 0.40 to 1.58) and major bleeding (HR 0.88; 95% CI 0.47 to 1.62), with no difference in the risk of GI bleeding (HR 0.99; 95% CI 0.63 to 1.55). Similar results were obtained in on-treatment analyses using a time-dependent exposure definition.Conclusions Our results suggest that in the UK primary care, NOACs are overall effective and safe alternatives to VKAs, among patients with NVAF altogether, as well as in patients with NVAF and CKD.https://bmjopen.bmj.com/content/8/1/e019638.full |
| spellingShingle | Samy Suissa James M Brophy Sophie Dell’Aniello Christel Renoux Simone Y Loo Janie Coulombe Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort study BMJ Open |
| title | Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort study |
| title_full | Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort study |
| title_fullStr | Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort study |
| title_full_unstemmed | Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort study |
| title_short | Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort study |
| title_sort | comparative effectiveness of novel oral anticoagulants in uk patients with non valvular atrial fibrillation and chronic kidney disease a matched cohort study |
| url | https://bmjopen.bmj.com/content/8/1/e019638.full |
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