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Atreja N, Severtson SG, Jiang J, Gao C, Hines DM, Cheng D, Hagan M, Breeze JL, Paulus JK, Secemsky EA. The Association between Direct Oral Anticoagulants Prescribing Behavior and Non-Valvular Atrial Fibrillation Outcomes: An Instrumental Variable Analysis of Real-World Data. J Clin Med 2023; 12:7190. [PMID: 38002802 PMCID: PMC10671855 DOI: 10.3390/jcm12227190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
Several observational studies have compared apixaban with rivaroxaban in patients with non-valvular atrial fibrillation (NVAF), but these analyses may be confounded by unmeasured characteristics. This study used provider prescribing preference (PPP) as an instrumental variable (IV) to assess the association between prescriber choice of rivaroxaban vs. apixaban and the study outcomes of stroke/systemic embolism (SE), major bleeding, and death in a retrospective cohort of NVAF patients in the US. Initiators of either medication were linked to their prescribers and followed until the first of the study outcome, the end of rivaroxaban/apixaban use, or 365 days after initiation. PPP for each patient was the percent of rivaroxaban initiations issued by the provider for the prior 10 NVAF patients. Cox regression models tested associations between quintiles of PPP and each outcome. A total of 61,155 patients and 1726 providers were included. The IV was a strong predictor of rivaroxaban prescription (OR = 17.9; 95% CI: 16.6, 19.3). There were statistically significant associations between increasing preference for rivaroxaban and rates of major bleeding (ptrend = 0.041) and death (ptrend = 0.031), but not stroke/SE (ptrend = 0.398). This analysis provides evidence of the relative safety of apixaban over rivaroxaban for the risk of major bleeding and death.
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Affiliation(s)
- Nipun Atreja
- Bristol Myers Squibb, Lawrenceville, NJ 08648, USA
| | | | - Jenny Jiang
- Bristol Myers Squibb, Lawrenceville, NJ 08648, USA
| | - Chuan Gao
- Bristol Myers Squibb, Lawrenceville, NJ 08648, USA
| | | | - Dong Cheng
- Bristol Myers Squibb, Lawrenceville, NJ 08648, USA
| | | | | | | | - Eric A. Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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2
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Mapili JAL, Lim LCS, Velando BM, Aherrera JAM. The safety and efficacy of direct oral anticoagulants among chronic kidney disease patients on dialysis with non-valvular atrial fibrillation: a meta-analysis. Front Cardiovasc Med 2023; 10:1261183. [PMID: 37795477 PMCID: PMC10545858 DOI: 10.3389/fcvm.2023.1261183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Individuals with chronic kidney disease (CKD) on dialysis are at an increased risk of stroke and embolic events especially in the presence of atrial fibrillation (AF). Vitamin K antagonists (VKA), including warfarin, have been used for decades for anticoagulation among CKD patients on dialysis with AF but recent evidence has shown increased bleeding. Direct oral anticoagulants (DOAC) have been emerging as an alternative to VKA which, based on several observational cohort studies, are at least as efficacious and safe as VKA. This meta-analysis looked into the safety and efficacy of DOACs compared to VKA among CKD patients on dialysis with non-valvular AF. Methodology This study used a random-effects meta-analysis using RevMan 5.4. PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched from their dates of inception to June 2023. The risk of bias was assessed using Cochrane RoB2 and the certainty of evidence was assessed using GRADE. Results This meta-analysis showed that DOACs when compared to VKA have no significant difference in terms of risk for major bleeding (RR = 0.81, 95% CI 0.46-1.43), ischemic stroke (RR = 0.5, 95% CI 0.19-1.35), and cardiovascular death (RR = 1.34, 95% CI 0.69-2.60). Discussion This meta-analysis adds to the growing body of evidence supporting that the use of DOACs has similar efficacy and safety outcomes in CKD patients on dialysis with non-valvular AF patients compared to VKA. The findings need to be replicated in larger and more adequately powered clinical trials in order to ascertain its level of evidence.
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Affiliation(s)
- Jerahmeel Aleson L. Mapili
- Division of Cardiovascular Medicine, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
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3
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Burnham KT, Yang T, Wooster J. A Real-World Comparison of Apixaban and Rivaroxaban in Obese and Morbidly Obese Patients With Nonvalvular Atrial Fibrillation. J Pharm Pract 2023:8971900231202643. [PMID: 37713139 DOI: 10.1177/08971900231202643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Background: Contemporary guidelines for managing nonvalvular atrial fibrillation (NVAF) include apixaban and rivaroxaban as first-line anticoagulation treatment options. Minimal guidance is available regarding selecting anticoagulants for patients with class I-III obesity. Objective: This study aims to evaluate the comparative effectiveness and safety of apixaban and rivaroxaban in both obese and morbidly obese patients with NVAF. Methods: A retrospective cohort study was conducted at an outpatient cardiovascular clinic after Institutional Review Board approval. Patients were eligible if they were ≥18 years of age, had a BMI ≥30 kg/m2, and took apixaban or rivaroxaban for NVAF for ≥3 months. The primary endpoint was the composite rate of stroke, transient ischemic attack (TIA), myocardial infarction (MI), or presence of atrial thrombosis. Bleeding events were evaluated as the primary safety endpoint. Results: Combined, the cohorts consisted of 303 obese or morbidly obese patients. The primary composite endpoint occurred in 3.8% of patients taking apixaban and 1.7% of patients taking rivaroxaban (P = .28). Both clinically relevant, non-major and major bleeding occurred more often in the apixaban arm, but this difference was not statistically significant; however, bleeding risk may have been skewed due to differences in baseline characteristics. Conclusion and Relevance: For obese and morbidly obese patients prescribed either apixaban or rivaroxaban for NVAF, rates of stroke, TIA, MI, and atrial thrombosis did not differ. The preferred DOAC for patients with class I-III obesity remains elusive, but current data points to a patient-centered approach for anticoagulant selection.
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Affiliation(s)
- Kevin T Burnham
- Department of Pharmacy, Methodist Health System, Dallas, TX, USA
| | - Tianrui Yang
- Fisch College of Pharmacy, The University of Texas at Tyler, Dallas, TX, USA
| | - Jessica Wooster
- Fisch College of Pharmacy, The University of Texas at Tyler, Dallas, TX, USA
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4
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Arora A, Kumar A, Anand AC, Kumar A, Yadav A, Bhagwat A, Mullasari AS, Satwik A, Saraya A, Mehta A, Roy D, Reddy DN, Makharia G, Murthy JMK, Roy J, Sawhney JPS, Prasad K, Goenka M, Philip M, Umaiorubahan M, Sinha N, Mohanan PP, Sylaja PN, Ramakrishna P, Kerkar P, Rai P, Kochhar R, Yadav R, Nijhawan S, Sinha SK, Hastak SM, Viswanathan S, Ghoshal UC, Madathipat U, Thakore V, Dhir V, Saraswat VA, Nabi Z. Position statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy. Indian J Gastroenterol 2023; 42:332-346. [PMID: 37273146 PMCID: PMC10240467 DOI: 10.1007/s12664-022-01324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/12/2022] [Indexed: 06/06/2023]
Abstract
Antiplatelet and/or anticoagulant agents (collectively known as antithrombotic agents) are used to reduce the risk of thromboembolic events in patients with conditions such as atrial fibrillation, acute coronary syndrome, recurrent stroke prevention, deep vein thrombosis, hypercoagulable states and endoprostheses. Antithrombotic-associated gastrointestinal (GI) bleeding is an increasing burden due to the growing population of advanced age with multiple comorbidities and the expanding indications for the use of antiplatelet agents and anticoagulants. GI bleeding in antithrombotic users is associated with an increase in short-term and long-term mortality. In addition, in recent decades, there has been an exponential increase in the use of diagnostic and therapeutic GI endoscopic procedures. Since endoscopic procedures hold an inherent risk of bleeding that depends on the type of endoscopy and patients' comorbidities, in patients already on antithrombotic therapies, the risk of procedure-related bleeding is further increased. Interrupting or modifying doses of these agents prior to any invasive procedures put these patients at increased risk of thromboembolic events. Although many international GI societies have published guidelines for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures, no Indian guidelines exist that cater to Indian gastroenterologists and their patients. In this regard, the Indian Society of Gastroenterology (ISG), in association with the Cardiological Society of India (CSI), Indian Academy of Neurology (IAN) and Vascular Society of India (VSI), have developed a "Guidance Document" for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures.
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Affiliation(s)
- Anil Arora
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
| | - Ashish Kumar
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Anil C Anand
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Kushabhadra Campus, 5, KIIT Road, Bhubaneswar, 751 024, India
| | - Ajay Kumar
- Department of Gastroenterology and Hepatology, BLK Max Multispeciality Hospital, Pusa Road, Radha Soami Satsang, Rajendra Place, New Delhi, 110 005, India
| | - Ajay Yadav
- Department of Vascular and Endovascular Surgery, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Ajit Bhagwat
- Department of Cardiology, Kamalnayan Bajaj Hospital, Gut No 43 Bajaj Marg, Beed Bypass Road, Satara Deolai Parisar, Aurangabad, 431 010, India
| | - Ajit S Mullasari
- Department of Adult Cardiology, Madras Medical Mission, 4-A, Dr. J. Jayalalitha Nagar, Chennai, 600 037, India
| | - Ambarish Satwik
- Department of Vascular and Endovascular Surgery, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, 110 029, India
| | - Ashwani Mehta
- Department of Cardiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Debabrata Roy
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, 124, Eastern Metropolitan Bypass, Mukundapur, Kolkata, 700 099, India
| | - Duvvur Nageshwar Reddy
- Department of Medical Gastroenterology, AIG Hospitals, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, 110 029, India
| | - Jagarapudi M K Murthy
- Department of Neurology, CARE Hospitals, Road No.1, Banjara Hills, Hyderabad, 500 034, India
| | - Jayanta Roy
- Department of Neurology, Institute of Neurosciences, 185/1, Acharya Jagadish Chandra Bose Road, Kolkata, 700 017, India
| | - Jitendra P S Sawhney
- Department of Cardiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Kameshwar Prasad
- Rajendra Institute of Medical Sciences, Bariatu, Ranchi, 834 009, India
| | - Mahesh Goenka
- Institute of Gastrosciences, Apollo Multispeciality Hospitals, 58, Canal Circular Road, Kadapara, Phool Bagan, Kankurgachi, Kolkata, 700 054, India
| | - Mathew Philip
- Department of Medical Gastroenterology, Lisie Hospital, Lisie Hospital Road, North Kaloor, Kaloor, Ernakulam, 682 018, India
| | - Meenakshisundaram Umaiorubahan
- Department of Neuro Science, SIMS Hospital, No.1, Jawaharlal Nehru Salai (100 Feet Road), Vadapalani, Chennai, 600 026, India
| | - Nakul Sinha
- Department of Cardiac Sciences, Medanta Super Speciality Hospital, Sector - A, Pocket - 1, Amar Shaheed Path, Golf City, Lucknow, 226 030, India
| | - Padinhare P Mohanan
- Department of Cardiology and Cardiothoracic Surgery, Westfort High-Tech Hospital, Guruayoor Road, Punkunnam, Thrissur, 680 002, India
| | - Padmavathy N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Jai Nagar W Road, Chalakkuzhi, Thiruvananthapuram, 695 011, India
| | - Pinjala Ramakrishna
- Department of Vascular Surgery, Apollo Hospital Jubilee Hills, Road No 72, Opp. Bharatiya Vidya Bhavan School Film Nagar, Jubilee Hills, Hyderabad, 500 033, India
| | - Prafulla Kerkar
- Department of Cardiology, KEM Hospital and Seth G. S. Medical College, Acharya Donde Marg, Parel East, Parel, Mumbai, 400 012, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Fortis Hospital, Sector 62, Phase - VIII, Mohali, 160 062, India
| | - Rakesh Yadav
- Department of Cardiology, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, 110 029, India
| | - Sandeep Nijhawan
- Department of Medical Gastroenterology, SMS Medical College and Hospitals, J.L.N. Marg, Jaipur, 302 004, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh, 160 012, India
| | - Shirish M Hastak
- Department of Neurology, Global Hospitals, 35, Dr. E Borges Road, Hospital Avenue, Opposite Shirodkar High School, Parel, Mumbai, 400 012, India
| | - Sidharth Viswanathan
- Department of Vascular and Endovascular Surgery, Amrita Institute of Medical Sciences, Ponekkara, AIMS (P.O.), Kochi, 682 041, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Unnikrishnan Madathipat
- Department of Vascular and Endovascular Surgery, SUT Pattom Multi Super Specialty Hospitals, Pattom, Thiruvananthapuram, 695 004, India
| | - Vijay Thakore
- Department of Vascular and Endovascular Surgery, Aadicura Superspeciality Hospital, Winward Business Park, Jetalpur Road, Vadodara, 390 020, India
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Raheja Rugnalaya Marg, Mahim West, Mahim, Mumbai, 400 016, India
| | - Vivek A Saraswat
- Department of Gastroenterology and Hepatology, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Tonk Road, Jaipur, 302 022, India
| | - Zaheer Nabi
- Department of Medical Gastroenterology, AIG Hospitals, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
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Martino FM, Bernardi M, Pingitore A, Biondi-Zoccai G. Another meta-analysis on novel oral anticoagulants for left ventricular thrombus: when enough is enough? J Cardiovasc Med (Hagerstown) 2023; 24:20-22. [PMID: 36574298 DOI: 10.2459/jcm.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences
| | - Annachiara Pingitore
- Department of General Surgery, Surgical Specialties and Organ Transplantation 'Paride Stefanini', Sapienza University of Rome, Rome
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina.,Mediterranea Cardiocentro, Napoli, Italy
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Barbarawi M, Barbarawi O, Corcoran J, Obeidat K, Al-Abdouh A, Mhanna M, Al Kasasbeh M, Pickett CC. Efficacy and Safety of the Non-Vitamin K Antagonist Oral Anticoagulant Among patients with nonvalvular atrial fibrillation and Cancer: A Systematic Review and Network Meta-analysis. Curr Probl Cardiol 2022; 47:101346. [PMID: 35932849 DOI: 10.1016/j.cpcardiol.2022.101346] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients with cancer are at higher risk of atrial fibrillation (AF). Currently there are no definitive data on clinical outcomes for nonvitamin K antagonist oral anticoagulant (NOACs) and warfarin in cancer patients with AF. Therefore, we conducted a meta-analysis to evaluate the efficacy and safety of NOACs compared with warfarin. METHODS A search through Pubmed/MEDLINE, Embase, and Cochrane library was done from the databases inception to March 2022. Studies that compared NOACs to warfarin in the setting of AF and cancer were included. The primary outcomes were the incidence of major bleeding and ischemic stroke/systemic embolism (SE). Secondary outcomes were major adverse cardiovascular event (MACE), intracranial bleeding, and Major gastrointestinal bleeding. Risk ratios (RRs) with 95% confidence intervals (CI) were used to report the outcomes. RESULTS A total of 11 studies were included. We found that NOACs were associated with a lower incidence of major bleeding and combined ischemic stroke/SE in patients with AF and cancer compared with warfarin (RR 0.57; 95% CI 0.44-0.75, P < 0.0001 and RR 0.59; 95% CI 0.47-0.75, P < 0.0001, respectively). Also, there was lower incidence of Intracranial and major gastrointestinal bleeding in patients who received NOACs compared with warfarin (P < 0.0001). Network analyses revealed that apixaban and dabigatran were associated with reduction of major bleeding compared with warfarin. CONCLUSIONS Among patients who diagnosed with AF and cancer, NOACs were associated with lower incidence of major bleeding ischemic stroke/SE compared with warfarin. Furthermore, NOACs were associated with lower gastrointestinal and intracranial bleeding.
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Affiliation(s)
- Mahmoud Barbarawi
- Department of cardiology, University of Connecticut, Farmington, CT, USA.
| | - Owais Barbarawi
- Department of Internal Medicine, Islamic Hospital, Amman, Jordan
| | - Jason Corcoran
- Department of Medicine, Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Khaldun Obeidat
- Departments of Medicine, Cook County Hospital, Chicago, IL, USA
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Mahammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Mariam Al Kasasbeh
- Department of Health Administration, Western Connecticut State University, CT, USA
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7
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Effectiveness and Safety of Nonvitamin K Oral Anticoagulants Rivaroxaban and Apixaban in Patients with Venous Thromboembolism: A Meta-Analysis of Real-World Studies. Cardiovasc Ther 2022; 2022:2756682. [PMID: 35801133 PMCID: PMC9203223 DOI: 10.1155/2022/2756682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Rivaroxaban and apixaban are the most widely used nonvitamin K oral anticoagulants (NOACs) in patients with venous thromboembolism (VTE). This meta-analysis evaluates the effectiveness and safety of both NOACs versus standard of care (SoC) in real-world practice. Methods Real-world evidence (RWE) studies were identified through a systematic literature review conducted between January 2012 and July 2020, using Embase, MEDLINE, and the websites of cardiological, hematological, and oncological associations. Eligible RWE studies recruited adult patients with deep vein thrombosis and/or pulmonary embolism and presented a comparison between rivaroxaban and apixaban versus SoC, consisting either of vitamin K antagonists, heparins, or combinations thereof. Hazard ratios (HRs) for the comparison between NOACs and SoC were extracted from the relevant studies or estimated based on the reported binary data. The between-treatment contrasts were reported as HRs with associated 95% confidence intervals. Results A total of 65 RWE studies were identified and considered relevant for the meta-analysis. Compared with SoC, both rivaroxaban and apixaban were associated with reduced risks of recurrent VTE and a lower rate of major bleeding events. Patients treated with rivaroxaban were at a lower risk of all-cause death compared with those receiving SoC (HR = 0.56 [0.39-0.80]), while evidence for apixaban from the identified studies was insufficient to demonstrate a statistically significant change in mortality (HR = 0.66 [0.30-1.47]). Conclusion This analysis indicates that in real-world practice, rivaroxaban and apixaban are associated with a lower risk of recurrent VTE and major bleeding events compared with SoC. Survival benefit in patients treated with rivaroxaban was also observed.
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Lip GYH, Kotalczyk A, Teutsch C, Diener HC, Dubner SJ, Halperin JL, Ma CS, Rothman KJ, Marler S, Gurusamy VK, Huisman MV. Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry. Clin Res Cardiol 2022; 111:560-573. [PMID: 35294625 PMCID: PMC9054878 DOI: 10.1007/s00392-022-01996-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Prospectively
collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-01996-2.
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Affiliation(s)
- Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK. .,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland. .,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Christine Teutsch
- Department of Cardiometabolism and Respiratory Medicine, Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Duisburg-Essen, Essen, Germany
| | - Sergio J Dubner
- Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | | | - Chang-Sheng Ma
- Cardiology Department, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Sabrina Marler
- Biostatistics and Data Sciences, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | | | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Meng L, Huang J, Qiu F, Shan X, Chen L, Sun S, Wang Y, Yang J. Peripheral Neuropathy During Concomitant Administration of Proteasome Inhibitors and Factor Xa Inhibitors: Identifying the Likelihood of Drug-Drug Interactions. Front Pharmacol 2022; 13:757415. [PMID: 35359859 PMCID: PMC8963930 DOI: 10.3389/fphar.2022.757415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds: Proteasome inhibitors (PI) cause toxic peripheral neuropathy (PN), which is one of the dose-limiting adverse events of these treatments. Recent preclinical studies find that factor Xa inhibitor (FXaI), rivaroxaban, promotes PN in animals receiving oxaliplatin. Cancer patients can receive combined therapy of PI and FXaI. This study aimed to identify and characterize the interaction signals for the concomitant use of PI and FXaI resulting in PN.Methods: Reports from the United States FDA Adverse Event Reporting System (FAERS) were extracted from the first quarter of 2004 to the first quarter of 2020 for analysis. The Standardized Medical Dictionary for Regulatory Activities (MedDRA) query was used to identify PN cases. We conducted an initial disproportionality investigation to detect PN adverse event signals associated with the combined use of PI and FXaI by estimating a reporting odds ratio (ROR) with a 95% confidence interval (CI). The adjusted RORs were then analyzed by logistic regression analysis (adjusting for age, gender, and reporting year), and additive/multiplicative models were performed to further confirm the findings. Additionally, subset data analysis was performed on the basis of a single drug of PI and FXaI.Results: A total of 159,317 adverse event reports (including 2,822 PN reports) were included. The combined use of PI and FXaI was associated with a higher reporting of PN (RORadj = 7.890, 95%CI, 5.321–11.698). The result remained significant based on additive/multiplicative methods. The observed association was consistent in the analysis restricted to all specific PI agents (bortezomib and ixazomib) and FXaI (rivaroxaban), except apixaban.Conclusion: Analysis of FAERS data identified reporting associations of PN in the combined use of PI and FXaI, suggesting the need for more robust preclinical and clinical studies to elucidate the relationship.
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Affiliation(s)
- Long Meng
- Key Laboratory of Biochemistry and Molecular Pharmacology, Department of Pharmacology, Chongqing Medical University, Chongqing, China
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Qiu
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Shan
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Chen
- Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
| | - Shusen Sun
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
- Department of Pharmacy, Xiangya Hospital Central South University, Changsha, China
| | - Yuwei Wang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Junqing Yang
- Key Laboratory of Biochemistry and Molecular Pharmacology, Department of Pharmacology, Chongqing Medical University, Chongqing, China
- *Correspondence: Junqing Yang,
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10
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Perreault S, Dragomir A, Côté R, Lenglet A, de Denus S, Dorais M, White-Guay B, Brophy J, Schnitzer ME, Dubé MP, Tardif JC. Comparative Effectiveness and Safety of Low-Dose Oral Anticoagulants in Patients With Atrial Fibrillation. Front Pharmacol 2022; 12:812018. [PMID: 35095525 PMCID: PMC8795908 DOI: 10.3389/fphar.2021.812018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: Observational studies of various dose levels of direct oral anticoagulants (DOACs) for patients with atrial fibrillation (AF) found that a high proportion of patients received a dose lower than the target dose tested in randomized controlled trials. There is a need to compare low-dose DOACs with warfarin or other DOACs on effectiveness and safety. Methods: Using administrative data from Quebec province, Canada, we built a cohort of new warfarin or DOAC users discharged from hospital between 2011 and 2017. We determined CHA2DS2-VASc and HAS-BLED scores, and comorbidities for 3-year prior cohort entry. The primary effectiveness endpoint was a composite of ischemic stroke/systemic embolism (SE), and secondary outcomes included a safety composite of major bleeding (MB) events and effectiveness composite (stroke/SE, death) at 1-year follow-up. We contrasted each low-dose DOAC with warfarin or other DOACs as references using inverse probability of treatment weighting to estimate marginal Cox hazard ratios (HRs). Results: The cohort comprised 22,969 patients (mean age: 80-86). We did not find a significant risk reduction for the stroke/SE primary effectiveness endpoint for DOACs vs. warfarin; however, we observed a significantly lower risk for low-dose dabigatran vs. warfarin (HR [95%CI]: 0.59 [0.42-0.81]) for effectiveness composite, mainly due to a lower death rate. The differences in effectiveness and safety composites between low-dose rivaroxaban vs. warfarin were not significant. However, low-dose apixaban had a better safety composite (HR: 0.68 [0.53-0.88]) vs. warfarin. Comparisons of dabigatran vs. apixaban showed a lower risk of stroke/SE (HR: 0.53 [0.30-0.93]) and a 2-fold higher risk of MB. The MB risk was higher for rivaroxaban than for apixaban (HR: 1.58 [1.09-2.29]). Conclusions: The results of this population-based study suggest that low-dose dabigatran has a better effective composite than warfarin. Compared with apixaban, low-dose dabigatran had a better effectiveness composite but a worse safety profile. Low-dose apixaban had a better safety composite than warfarin and other low-dose DOACs. Given that the comparative effectiveness and safety seem to vary from one DOAC to another, pharmacokinetic data for specific populations are now warranted.
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Affiliation(s)
- Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Alice Dragomir
- Department of Urology, Faculty of Medicine, University McGill, Montreal, QC, Canada
| | - Robert Côté
- Faculty of Medicine, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Aurélie Lenglet
- Laboratory MP3CV, Faculty of Pharmacy, University of Picardie Jules Verne, Amiens, France.,Pharmacy, Amiens University Medical Center, Amiens, France
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.,Montreal Heart Institute, Montreal, QC, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l'Île-Perrot, QC, Canada
| | - Brian White-Guay
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - James Brophy
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Marie-Pierre Dubé
- Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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11
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Perreault S, Dragomir A, Côté R, Lenglet A, White-Guay B, de Denus S, Schnitzer ME, Dubé MP, Brophy JM, Dorais M, Tardif JC. Comparative effectiveness and safety of high-dose rivaroxaban and apixaban for atrial fibrillation: A propensity score-matched cohort study. Pharmacotherapy 2021; 41:379-393. [PMID: 33544915 DOI: 10.1002/phar.2509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVE Observational studies assessing direct oral anticoagulant (DOACs) dosage in atrial fibrillation (AF) reported that a lower proportion of patients received high-dose DOACs compared to those in randomized controlled trials (RCTs). Effectiveness and safety of high-dose DOACs relative to apixaban in a real-world AF population need to be addressed. The aim is to assess comparative effectiveness and safety of high-dose rivaroxaban relative to apixaban. DESIGN We conducted a cohort study. Setting We built a cohort of patients hospitalized and discharged in community with a primary or secondary AF diagnosis from 2011-2017 using Quebec administrative databases (Med-Echo and RAMQ). Patients Cohort entry was defined as the first OAC claim in new users of high-dose rivaroxaban and apixaban, with no OAC claims in the prior year. Intervention To compare effectiveness and safety of high-dose rivaroxaban to apixaban. Measurement We ascertained patient demographics, comorbidities, CHA2DS2-VASc and HASBLED scores and Charlson score within 3 years prior to cohort entry. Primary effectiveness and safety were a composite of ischemic stroke/systemic thrombosis, death, myocardial infarction, and of intracranial bleeding (ICH), extracranial major bleeding, in the first year following drug initiation. We conducted propensity score matching and estimated hazard ratios (HRs) for outcomes using Cox proportional hazard models. All the analyses were conducted to account for competing risks. Main results The cohort consisted of 4,632 and 6,771 patients received high-dose rivaroxaban and apixaban, respectively. High-dose rivaroxaban users were younger with a mean age of 73.2 years, presented less associated comorbidities and had lower CHA2DS2-VASc scores compared to apixaban. High-dose rivaroxaban at the intention to treat was associated with a higher risk of stroke/SE/death (HR 1.21, 95% CI 1.04-1.40) and worse composite effectiveness (HR 1.21: 1.05-1.40); under treatment exposure, those values were at HR (1.66: 1.21-2.29) and HR (1.58:1.19-2.10), respectively. And, rivaroxaban presented a less favorable safety profile relative to apixaban. Conclusion In this study, composite effectiveness and safety varied between rivaroxaban and apixaban. High-dose apixaban was observed to have a better effectiveness and safety.
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Affiliation(s)
- Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Alice Dragomir
- Faculty of Medicine, Department of Urology, McGill University, Montreal, Quebec, Canada
| | - Robert Côté
- Faculty of Medicine, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Aurélie Lenglet
- Faculty of Pharmacy, EA 7517, Laboratory MP3CV, Jules Verne University of Picardie, Amiens, France.,Department of Pharmacy, Amiens-Picardie University Hospital, Amiens, France
| | - Brian White-Guay
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada
| | - Mireille E Schnitzer
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pierre Dubé
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada
| | - James M Brophy
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l'Île-Perrot, Quebec, Canada
| | - Jean-Claude Tardif
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada
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12
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Affiliation(s)
- Gregory F Michaud
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville
| | - William G Stevenson
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville
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13
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Gorczyca I, Jelonek O, Uziębło-Życzkowska B, Chrapek M, Maciorowska M, Wójcik M, Błaszczyk R, Kapłon-Cieślicka A, Gawałko M, Budnik M, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Wożakowska-Kapłon B. Trends in the Prescription of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation: Results of the Polish Atrial Fibrillation (POL-AF) Registry. J Clin Med 2020; 9:jcm9113565. [PMID: 33167503 PMCID: PMC7694480 DOI: 10.3390/jcm9113565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Current guidelines do not suggest in which groups of patients with atrial fibrillation (AF) individual non-vitamin K antagonist oral anticoagulants (NOACs) should be used for the prevention of thromboembolic complications. The aim of this study was to evaluate the frequency of use of apixaban, dabigatran, and rivaroxaban, and attempt to identify factors predisposing their administration. Methods: The Polish Atrial Fibrillation (POL-AF) registry is a prospective, non-interventional study, including consecutive patients with AF hospitalized in ten Polish cardiology centers during the period ranging from January to December 2019. In this study, all patients were treated with NOACs. Results: Among the 2971 patients included in the analysis, 40.4% were treated with rivaroxaban, 32% with apixaban, and 27.6% with dabigatran. The mean age of the total population was 72 ± 11.5 years and 43% were female. A reduced dose of NOAC was used in 35% of patients treated with apixaban, 39.7% of patients treated with dabigatran, and 34.4% of patients treated with rivaroxaban. Independent predictors of the use of apixaban were previous bleeding (OR 2.37, CI 1.67–3.38), GFR < 60 mL/min (OR 1.38, CI 1.25–1.64), heart failure (OR 1.38, CI 1.14–1.67) and age (per 5 years) (OR 1.14, CI 1.09–1.19). GFR < 60 mL/min (OR 0.79, CI 0.66–0.95), female (OR 0.8, CI 0.67–0.96) and age (per 5 years) (OR 0.95, CI 0.91–0.99) diminished the chance of using dabigatran. Previous bleeding (OR 0.43, CI 0.28–0.64), vascular disease (OR 0.84, CI 0.70–0.99), and age (per 5 years) (OR 0.94, CI 0.90–0.97) diminished the chance of choosing rivaroxaban. Conclusions: In hospitalized patients with AF, the most frequently chosen NOAC was rivaroxaban. Apixaban was chosen more often in patients after bleeding, and in those who were advanced in years, with heart failure and impaired renal function. Impaired renal function and female gender were factors that diminished the chance of using dabigatran. Previous bleeding and vascular disease was the factor that diminished the chance of using rivaroxaban. Dabigatran and rivaroxaban have been used less frequently in elderly patients.
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Affiliation(s)
- Iwona Gorczyca
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Olga Jelonek
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland;
- Correspondence: ; Tel.: +48-261-816-376
| | - Magdalena Chrapek
- Faculty of Natural Sciences, The Jan Kochanowski University, 25-369 Kielce, Poland;
| | - Małgorzata Maciorowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (M.W.); (R.B.)
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (M.W.); (R.B.)
| | - Agnieszka Kapłon-Cieślicka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.-C.); (M.G.); (M.B.)
| | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.-C.); (M.G.); (M.B.)
| | - Monika Budnik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.-C.); (M.G.); (M.B.)
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (T.T.); (R.R.-S.)
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (T.T.); (R.R.-S.)
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (J.B.); (M.W.)
| | - Michał Wojewódzki
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (J.B.); (M.W.)
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swiętokrzyski, Poland;
| | - Janusz Bednarski
- Department of Cardiology, St John Paul II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland; (J.B.); (E.B.-O.)
| | - Elwira Bakuła-Ostalska
- Department of Cardiology, St John Paul II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland; (J.B.); (E.B.-O.)
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University, 15-276 Bialystok, Poland; (A.T.-K.); (A.S.)
| | - Anna Szyszkowska
- Department of Cardiology, Medical University, 15-276 Bialystok, Poland; (A.T.-K.); (A.S.)
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, 02-091 Warsaw, Poland; (M.W.); (A.M.)
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, 02-091 Warsaw, Poland; (M.W.); (A.M.)
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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14
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Reçber T, Haznedaroğlu İC, Çelebier M. Review on Characteristics and Analytical Methods of Rivaroxaban. Crit Rev Anal Chem 2020; 52:865-877. [DOI: 10.1080/10408347.2020.1839735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Tuba Reçber
- Faculty of Pharmacy, Department of Analytical Chemistry, Hacettepe University, Ankara, Turkey
| | | | - Mustafa Çelebier
- Faculty of Pharmacy, Department of Analytical Chemistry, Hacettepe University, Ankara, Turkey
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15
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Brønnum Nielsen P, Søgaard M. Letter by Nielsen and Søgaard Regarding Article, "Rivaroxaban Versus Apixaban for Stroke Prevention in Atrial Fibrillation: An Instrumental Variable Analysis of a Nationwide Cohort". Circ Cardiovasc Qual Outcomes 2020; 13:e006889. [PMID: 32813565 DOI: 10.1161/circoutcomes.120.006889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Brønnum Nielsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark (P.B.N., M.S.).,Department of Cardiology, Aalborg University Hospital, Denmark (P.B.N., M.S.)
| | - Mette Søgaard
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark (P.B.N., M.S.).,Department of Cardiology, Aalborg University Hospital, Denmark (P.B.N., M.S.)
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16
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Bonde AN, Martinussen T. Response by Bonde and Martinussen to Letter Regarding Article, “Rivaroxaban Versus Apixaban for Stroke Prevention in Atrial Fibrillation: An Instrumental Variable Analysis of a Nationwide Cohort”. Circ Cardiovasc Qual Outcomes 2020; 13:e007003. [DOI: 10.1161/circoutcomes.120.007003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anders Nissen Bonde
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark (A.N.B.)
| | - Torben Martinussen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Denmark (T.M.)
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17
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Affiliation(s)
- Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research, Department of Health Sciences Research, and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Peter A. Noseworthy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research, Department of Health Sciences Research, and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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