Comparative Bleeding Risk in Older Patients With HIV and Atrial Fibrillation Receiving Oral Anticoagulants

Area of Science:

• Cardiology
• Infectious Diseases
• Pharmacology

Background:

• Patients with HIV and atrial fibrillation (AF) often require anticoagulation, posing potential interactions with antiretroviral therapy (ART).
• Limited comparative safety data exists for oral anticoagulants in this specific patient population.

Purpose of the Study:

• To compare the risk of major bleeding among users of warfarin, rivaroxaban, and apixaban in a US national cohort of patients with AF and HIV.
• To evaluate secondary outcomes including gastrointestinal bleeding, ischemic stroke, and all-cause mortality.

Main Methods:

• A new-user, active-comparator cohort study using Medicare claims data (2013-2020).
• Propensity score overlap weighting and target trial emulation framework were employed.
• Included patients aged 50+ with nonvalvular AF and HIV initiating warfarin, rivaroxaban, or apixaban.

Main Results:

• Warfarin and rivaroxaban were associated with significantly higher rates of major bleeding compared to apixaban.
• This increased bleeding risk was more pronounced in patients concurrently using ART.
• No significant differences were found in ischemic stroke or all-cause mortality rates among the anticoagulants.

Conclusions:

• Apixaban demonstrates a superior safety profile regarding major bleeding in patients with HIV and AF, especially those on ART.
• Warfarin and rivaroxaban present higher bleeding risks in this population.
• Further research should focus on optimizing anticoagulation strategies for HIV patients with AF.