Effectiveness and safety of rivaroxaban versus warfarin among nonvalvular atrial fibrillation patients with obesity and diabetes

• Published in: Journal of diabetes and its complications Vol. 35; no. 11; p. 108029
• Main Authors: Weir, Matthew R., Chen, Yen-Wen, He, Jinghua, Bookhart, Brahim, Campbell, Alicia, Ashton, Veronica
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Algorithms; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Anticoagulation; Antidiabetics; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Body mass index; Cardiac arrhythmia; Comorbidity; Diabetes; Diabetes mellitus; Diabetes Mellitus - drug therapy; Diabetes Mellitus - epidemiology; Embolism; Gastrointestinal surgery; Generic products; Health care policy; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Medicare; Nonvalvular atrial fibrillation; Obesity; Obesity - complications; Obesity - epidemiology; Pharmacy; Population; Retrospective Studies; Rivaroxaban; Rivaroxaban - adverse effects; Rivaroxaban - therapeutic use; Stroke; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Treatment Outcome; Warfarin; Warfarin - adverse effects; Warfarin - therapeutic use; United States > US; Obesity; Rivaroxaban; Warfarin; Anticoagulation; Nonvalvular atrial fibrillation; Diabetes mellitus
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2021.108029

To compare clinical outcomes of rivaroxaban and warfarin in patients with nonvalvular atrial fibrillation (NVAF) and concurrent obesity and diabetes. 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. 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). 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. •Stroke/systemic embolism risk was significantly lower with rivaroxaban versus warfarin.•Results were consistent for risks of ischemic and hemorrhagic stroke.•Major bleeding risk was similar for rivaroxaban and warfarin.