| アブストラクト | AIMS: To assess whether rivaroxaban is associated with a decreased risk of major adverse limb events (MALE), stroke, systemic embolism (SE), and major bleeding (MB) among patients with non-valvular atrial fibrillation (NVAF) and peripheral artery disease (PAD), compared with apixaban. METHODS AND RESULTS: We conducted a population-based cohort study using the UK Clinical Practice Research Datalink. Patients aged >/=45 years with incident NVAF and PAD who initiated rivaroxaban or apixaban between 2013 and 2021 were included. Primary effectiveness outcomes were MALE, and a composite of ischaemic stroke, transient ischaemic attack (TIA), or SE. The primary safety outcome was MB. The risk of major cardiovascular events (MACE) was assessed as a secondary outcome. Confounding was addressed using propensity score fine stratification and weighting. Weighted Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). The cohort included 6170 new users of rivaroxaban and 9990 new users of apixaban (44% female; mean [SD] age 78.5 [9.2] years). Incidence rates were similar for MALE (6.7 vs. 5.6/1000 person-years; adjusted HR (aHR): 1.20; 95% CI 0.87-1.65), stroke/TIA/SE (24.5 vs. 21.3/1000 person-years; aHR: 1.15; 95% CI 0.97-1.36), and MACE (40.1 vs. 35.9 per 1000 person-years; aHR 1.10: 95% CI 0.94-1.28). Major bleeding rates were higher with rivaroxaban (46.1 vs. 29.8/1000 person-years; aHR: 1.55; 95% CI 1.36-1.77). CONCLUSION: In patients with NVAF and PAD, rivaroxaban was associated with a similar risk of MALE and stroke/TIA/SE, but a higher risk of MB compared with apixaban. These findings support apixaban as a potentially safer anticoagulant in this high-risk population. |
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| 組織名 | Department of Epidemiology, Biostatistics and Occupational Health, McGill;University, 2001 Av. McGill College, Montreal, QC H3A 1Y7, Canada.;Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research,;Jewish General Hospital, 3755 Cote Sainte Catherine H 416.1, Montreal, QC H3T;1E2, Canada.;Department of Vascular Medicine, Bordeaux University Hospital, 1 rue Jean;Burguet, 33000 Bordeaux, France.;Bordeaux Population Health, Inserm Unit 1219, 146 rue Leo Saignat, 33000;Bordeaux, France.;Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada.;Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A;1A1, Canada. |
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