Uncertainty on the effectiveness and safety of rivaroxaban in premenopausal women with atrial fibrillation: empirical evidence needed

BMC Cardiovascular Disorders

Research Article

Herbert J. A. Rolden¹  Gert Jan van der Wilt²  Janneke P. C. Grutters²  Angela H. E. M. Maas³ 

[1] Council for Public Health and Society, The Hague, The Netherlands;Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands;Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands;Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands;

关键词: Abnormal uterine bleeding;    Atrial fibrillation;    Premenopausal women;    Rivaroxaban;    Value of information;    Vitamin K antagonists;   

DOI  :  10.1186/s12872-017-0692-1

 received in 2017-01-18, accepted in 2017-10-03,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundNovel anticoagulations (NOACs) are increasingly prescribed for the prevention of stroke in premenopausal women with atrial fibrillation. Small studies suggest NOACs are associated with a higher risk of abnormal uterine bleeds than vitamin K antagonists (VKAs). Because there is no direct empirical evidence on the benefit/risk profile of rivaroxaban compared to VKAs in this subgroup, we synthesize available indirect evidence, estimate decision uncertainty on the treatments, and assess whether further research in premenopausal women is warranted.MethodsA Markov model with annual cycles and a lifetime horizon was developed comparing rivaroxaban (the most frequently prescribed NOAC in this population) and VKAs. Clinical event rates, associated quality adjusted life years, and health care costs were obtained from different sources and adjusted for gender, age, and history of stroke. A Monte Carlo simulation with 10,000 iterations was then performed for a hypothetical cohort of premenopausal women, estimated to be reflective of the population of premenopausal women with AF in The Netherlands.ResultsIn the simulation, rivaroxaban is the better treatment option for the prevention of ischemic strokes in premenopausal women in 61% of the iterations. Similarly, this is 98% for intracranial hemorrhages, 24% for major abnormal uterine bleeds, 1% for minor abnormal uterine bleeds, 9% for other major extracranial hemorrhages, and 23% for other minor extracranial hemorrhages. There is a 78% chance that rivaroxaban offers the most quality-adjusted life years. The expected value of perfect information in The Netherlands equals 122 quality-adjusted life years and 22 million Euros.ConclusionsThere is a 22% risk that rivaroxaban offers a worse rather than a better benefit/risk profile than vitamin K antagonists in premenopausal women. Although rivaroxaban is preferred over VKAs in this population, further research is warranted, and should preferably take the shape of an internationally coordinated registry study including other NOACs.

【 授权许可】

CC BY   
© The Author(s). 2017