Factor Xa Inhibitors tied to interstitial lung disease in patients with nonvalvular atrial fibrillation

The cohort study of more than 100,000 patients in Taiwan was published online November 22 in JAMA Network Open. In patients with nonvalvular atrial fibrillation (NVAF), treatment with factor Xa (FXa) inhibitors was associated with a greater risk of interstitial lung disease (ILD) than other oral anticoagulants (OACs), a medical records analysis shows.

The analysis of data from the Taiwan National Health Insurance Research Database included 106,044 patients with NVAF (mean age, 73.4 years; 56.6% men) without pre-existing lung disease who were treated with OACs from 2012 to 2017 (FXa inhibitors, dabigatran, and warfarin, with warfarin as the reference). The authors used propensity score stabilized weighting (PSSW).

Among the 106 044 patients included in the study, 60.9% received FXa inhibitors (apixban [24%], edoxaban [19%], and rivaroxaban [57%]), 21.2% received dabigatran, and 17.9% received warfarin at baseline. The FXa inhibitors were associated with a higher risk of incident ILD (0.29 vs 0.17 per 100 patient-years; hazard ratio, 1.54 [95% CI, 1.22-1.94]; P < .001), whereas dabigatran was associated with a nonsignificant difference in risk of incident ILD compared with warfarin (reference) after PSSW.

Furthermore, patients who were diagnosed with ILD during follow-up and treated with FXa inhibitors had a higher risk of ILD requiring consequent antifibrotic agents than those treated with warfarin (odds ratio, 3.01).

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