Sex‐Specific Associations of Oral Anticoagulant Use and Cardiovascular Outcomes in Patients With Atrial Fibrillation

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

卷:6

Prashant D. Bhave¹  Nileshkumar Patel²  Samir Pancholy³  Abhishek Deshmukh⁴  Hakan Oral⁵  Mary S. Vaughan Sarrazin⁶  Viraj Bhise⁷  Ghanshyam Palamaner Subash Shantha⁸  Amgad Mentias⁸  Chakradhari Inampudi⁸  Kongkiat Chaikriangkrai⁸  Phillip A. Horwitz⁸  Steven Mickelsen⁸  Michael Giudici⁸  Anita A. Kumar⁹ 

[1] Cardiology Division/Electrophysiology Section, Wake Forest Baptist Hospital, Winston‐Salem, NC;

[2] Department of Cardiology, Jackson Memorial Hospital, University of Miami, FL;

[3] Department of Cardiovascular Medicine, The Wright Center for Graduate Medical Education, Scranton, PA;

[4] Department of Electrophysiology, Mayo Clinic, Rochester, MN;

[5] Department of Electrophysiology, University of Michigan, Ann Arbor, MI;

[6] Department of Internal Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa, Iowa City, IA;

[7] Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, TX;

[8] Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA;

[9] Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD;

关键词: atrial fibrillation;    heart failure;    mortality;    myocardial infarction;    sex;   

DOI  :  10.1161/JAHA.117.006381

来源: DOAJ

【 摘 要 】

BackgroundSex‐specific effectiveness of rivaroxaban (RIVA), dabigatran (DABI), and warfarin in reducing myocardial infarction (MI), heart failure (HF), and all‐cause mortality among patients with atrial fibrillation are not known. We assessed sex‐specific associations of RIVA, DABI, or warfarin use with the risk of MI, HF, and all‐cause mortality among patients with atrial fibrillation. Methods and ResultsMedicare beneficiaries (men: 65 734 [44.8%], women: 81 135 [55.2%]) with atrial fibrillation who initiated oral anticoagulants formed the study cohort. Inpatient admissions for MI, HF, and all‐cause mortality were compared between the 3 drugs separately for men and women using 3‐way propensity‐matched samples. In men, RIVA use was associated with a reduced risk of MI admissions compared with warfarin use (hazard ratio [95% confidence interval (CI): 0.59 [0.38–0.91]), with a trend towards reduced risk compared with DABI use (0.67 [0.44–1.01]). In women, there were no significant differences in the risk of MI admissions across all 3 anticoagulants. In both sexes, RIVA use and DABI use were associated with reduced risk of HF admissions (men: RIVA; 0.75 [0.63–0.89], DABI; 0.81 [0.69–0.96]) (women: RIVA; 0.64 [0.56–0.74], DABI; 0.73 [0.63–0.83]) and all‐cause mortality (men: RIVA; 0.66 [0.53–0.81], DABI; 0.75 [0.61–0.93]) (women: RIVA; 0.76 [0.63–0.91], DABI; 0.77 [0.64–0.93]) compared with warfarin use. ConclusionsRIVA use and DABI use when compared with warfarin use was associated with a reduced risk of HF admissions and all‐cause mortality in both sexes. However, reduced risk of MI admissions noted with RIVA use appears to be limited to men.

【 授权许可】

Unknown