. Methods: We conducted a new user, active comparator cohort study in a United States-based commercial claims database spanning 2013 through 2020 to quantify the comparative risk of fracture associated with select DOACs (apixaban or rivaroxaban) versus warfarin. Individuals were required to have International Classification of Diseases diagnosis codes for CKD (stages 3-5) and atrial fibrillation during the 365-day baseline period before anticoagulant initiation. Primary analyses quantified non-vertebral fracture risk between patients initiating DOACs and warfarin using a 1:1 propensity score-matched design. Cox proportional hazards regression was used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of non-vertebral fracture. Secondary analyses evaluated risks of hip fracture and all-cause mortality. Results: The 1:1 propensity score-matched population included 14,370 DOAC initiators and 14,370 warfarin initiators. The mean age at anticoagulant initiation was 77 years, and 45% were female. The HR for non-vertebral fracture comparing DOACs to warfarin was 1.12 (95% CI 0.95, 1.32), and the corresponding incidence rate difference (IRD) per 1,000 person-years was 3.55 (95% CI -1.67, 8.76). The HR and IRD comparing DOACs to warfarin were 0.98 (95% CI 0.68, 1.41) and -0.13 (95% CI, -2.52, 2.25), respectively for hip fracture and 0.91 (95% CI 0.85, 0.98) and -17.23 (95% CI, -29.49, -4.96), respectively for all-cause mortality. Conclusions: In patients with CKD and atrial fibrillation, we did not observe a difference in the rates of fracture between DOAC and warfarin initiators. DOAC use relative to warfarin was associated with a lower risk of all-cause mortality. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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慢性肾脏病和心房颤动患者抗凝治疗相关的骨折


.方法： 我们在 2013 年至 2020 年的美国商业索赔数据库中进行了一项新的用户、主动对照队列研究，以量化与特定 DOACs （阿哌沙班或利伐沙班） 与华法林相关的骨折比较风险。个体需要在抗凝剂开始前的 365 天基线期内具有 CKD （3-5 期） 和心房颤动的国际疾病分类诊断代码。初步分析使用 1：1 倾向评分匹配设计量化了开始 DOAC 和华法林的患者之间的非椎体骨折风险。采用 Cox 比例风险回归获得非椎体骨折的风险比 （HRs） 和 95% 置信区间 （CIs）。二次分析评估了髋部骨折的风险和全因死亡率。结果： 1：1 倾向评分匹配的人群包括 14,370 例 DOAC 起始剂和 14,370 例华法林起始剂。开始抗凝治疗的平均年龄为 77 岁，其中 45% 为女性。DOAC 与华法林相比，非椎体骨折的 HR 为 1.12 （95% CI 0.95， 1.32），相应的发病率差异 （IRD） 为 3.55/1,000 人年 （95% CI -1.67， 8.76）。髋部骨折的 DOAC 与华法林比较的 HR 和 IRD 分别为 0.98 （95% CI 0.68， 1.41） 和 -0.13 （95% CI， -2.52， 2.25），全因死亡率分别为 0.91 （95% CI 0.85， 0.98） 和 -17.23 （95% CI， -29.49， -4.96）。结论： 在 CKD 合并心房颤动患者中，我们未观察到 DOAC 和华法林启动剂之间的骨折率存在差异。相对于华法林，DOAC 的使用与全因死亡风险较低相关。美国肾脏病学会版权所有 © 2024...