The Comparative Effectiveness and Safety of Rivaroxaban and Warfarin Initiation in Adults with Atrial Fibrillation (AF) by eGFR Category
Bibliographic record
Abstract
Background: The risk-benefit ratio of rivaroxaban, a commonly prescribed direct oral anticoagulant, relative to warfarin in patients with atrial fibrillation (AF) and CKD is uncertain. Methods: We conducted an international multicenter cohort study(2011-2018) using healthcare data from 5 jurisdictions across Australia (530 participants of the 45 and Up Study [among 267153 recruited in 2006-09] with data, accessed via SURE, linked to hospital/laboratory data [by CHeReL] and the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data provided by Services Australia) and Canada (55038 patients in AB,BC,MB,ON; record linkage of provincial administrative/laboratory data). We propensity score matched adults with a new dispensation of rivaroxaban or warfarin, who had AF and a recorded eGFR grouped as≥60,45-59,30-44 and <30 ml/min/1.73m2. Chronic dialysis or kidney transplant recipients were excluded. We assessed 2 composite outcomes within 1 year of initiating either therapy: ischemic (all-cause death, ischemic stroke or transient ischemic attack) and bleeding events (intracranial, gastrointestinal or other). We used Cox regression to estimate the hazard ratios of each outcome across eGFR categories and summarized centre data in random effects meta-analysis. Results: Of the 55568 matched rivaroxaban and warfarin users, 4733(8.5%) experienced an ischemic event and 1144(2%) a bleeding event. As compared to warfarin initiation, rivaroxaban initiation was associated with lower or similar hazard for the ischemic outcome HR(95% CI) of 0.72(0.66-0.78), 0.82(0.58-1.16), 0.70(0.57-0.87) and 0.78(0.62-0.99), for eGFR ≥60, 45-59, 30-44 and <30ml/min/1.73m2 respectively. Rivaroxaban initiation was also associated with lower or similar hazard for the bleeding outcome (0.70[0.49-1.00], 1.00[0.78-1.29], 0.85[0.64-1.12], 0.61[0.35-1.05]). We observed no evidence of heterogeneity across centers except for eGFR 45-59ml/min/1.73m2 for the ischemic outcome(I2=77%) and ≥60ml/min/1.73m2 for the bleeding outcome(I2=62%). Conclusions: Compared to warfarin, rivaroxaban initiation was associated with lower or similar risk of both ischemic and bleeding outcomes independent of eGFR. Sufficiently powered randomized trials are needed to confirm findings from this large international cohort. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".