Arrhythmias & electrophysiology
Comparative Bleeding Risk in Older Patients With HIV and Atrial Fibrillation Receiving Oral Anticoagulants
Authors' conclusion
This study found that in patients with HIV and AF, especially those treated with ART, warfarin and rivaroxaban were associated with higher rates of major bleeding compared with apixaban, suggesting a superior safety profile for apixaban in this high-risk population.
Study context
- Population
- New initiators of oral anticoagulants aged 50 years or older with nonvalvular atrial fibrillation (AF) and HIVthree pairwise comparison cohorts · warfarin vs apixaban cohort 2,683 · rivaroxaban vs apixaban cohort 2,176 · rivaroxaban vs warfarin cohort 1,787
- Exposure
- Warfarin vs apixaban, rivaroxaban vs apixaban, and rivaroxaban vs warfarin
- Outcome
- hospitalization for major bleeding
Methodological detailsMedicare claims database data (January 1, 2013, to December 31, 2020)
- Medicare claims database data (January 1, 2013, to December 31, 2020)
Main finding
As reported in the abstract
Each group vs apixabanHazard ratio (95% CI)
Warfarinafter propensity score overlap weighting
2.60(1.51–4.49)
Warfarinpatients taking concurrent ART (71% of patients)
6.68(2.78–16.02)
Rivaroxaban
2.15(1.18–3.94)
Rivaroxabanthose using ART
4.83(2.11–11.08)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| Gastrointestinal bleedingWarfarinvs apixabanMajor gastrointestinal bleeding | 2.99 (1.52–5.90) | |
| Gastrointestinal bleedingWarfarinvs apixabanPatients taking concurrent ART | 5.28 (2.08–13.42) | |
| Gastrointestinal bleedingRivaroxabanvs apixaban | 3.38 (1.57–7.25) | |
| Gastrointestinal bleedingRivaroxabanvs apixabanThose using ART | 4.76 (1.78–12.70) | |
| 0.050.21520Hazard ratio (log scale) |
Ischemic stroke and mortality
- No significant difference was observed in the rate of ischemic stroke or mortality among the 3 oral anticoagulants
Original publication
Comparative Bleeding Risk in Older Patients With HIV and Atrial Fibrillation Receiving Oral Anticoagulants. JAMA Intern Med. Published 1 April 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →