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Abstract: FR-PO374

Direct Oral Anticoagulants vs Warfarin: Stroke Outcomes in CKD Patients

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Edgett, Drake Anthony, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Dratch, Alissa, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Tantisattamo, Ekamol, University of California, Irvine School of Medicine, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Lau, Wei Ling, University of California, Irvine School of Medicine, Orange, California, United States
Background

CKD patients are at higher risk of ischemic and hemorrhagic stroke. For over 50 years warfarin was the only oral anticoagulant available for stroke prevention. Direct Oral Anticoagulants (DOACs) became available in the past decade but outcomes data in CKD is limited. In this project we examined ischemic stroke outcomes associated with warfarin vs. DOAC therapy in the OptumLabs® Data Warehouse (OLDW).

Methods

This was a retrospective analysis of de-identified claims and electronic health record data for privately insured and Medicare Advantage enrollees in a large, private, U.S. health plan. Adults aged ≥18 years with claims data between 10/1/2010-11/30/2017 were included. Stroke events were captured between index prescription date and censor date (earliest date of index medication stopped, death, or end of follow up). Cox models were used to calculate hazard ratios of time to first stroke. Poisson models were used for stroke incident rate ratios. Associations were evaluated with multivariable adjustment for age, gender, race and baseline comorbidities (diabetes, hypertension, heart failure, myocardial infarction, prior stroke, antiplatelet medications).

Results

The cohort included 340,732 patients of which 90% were non-CKD, 9% were CKD stage 3-4, and 1% were CKD stage 5/ESRD. Patients had a mean±SD age of 67±13 years, and included 30% diabetics, 10% African-Americans and 6% Hispanic. Patients on warfarin were more likely to be older, African-American, ESRD, and have pre-existing comorbidities. Across all strata, patients on warfarin had a faster time to first stroke and a higher incidence of stroke events [Table].

Conclusion

In a large nationwide database, DOACs were associated with a lower risk of ischemic stroke as compared to warfarin therapy. Randomized controlled trials are warranted to further investigate this observed superiority of the newer anticoagulant therapies.