TY - JOUR

T1 - Dose reduction of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

T2 - A Danish nationwide cohort study

AU - Xing, Lucas Yixi

AU - Barcella, Carlo Alberto

AU - Sindet-Pedersen, Caroline

AU - Bonde, Anders Nissen

AU - Gislason, Gunnar Hilmar

AU - Olesen, Jonas Bjerring

PY - 2019/6

Y1 - 2019/6

N2 - Introduction: To investigate the patterns of dose reduction of non-vitamin K antagonist oral anticoagulants (NOAC) in patients with atrial fibrillation (AF). Materials and methods: Using Danish nationwide registries, we identified all non-valvular AF patients initiated on standard-dose NOAC during 2011–2017 who were followed until dose reduction. The absolute risk of dose reduction was presented as cumulative incidence both overall and according to baseline characteristics. Moreover, to assess baseline comorbidities related to dose reduction, adjusted Cox regression models were used. In subgroup analysis, we investigated dose reduction following acute myocardial infarction and/or percutaneous coronary intervention (MI/PCI), chronic kidney disease (CKD), turned 80 years, intracranial hemorrhage, peripheral bleeding, ischemic stroke, cancer, bone fracture, and antiplatelet treatment start. Results: Of 24,489 patients included, 12.2% experienced dose reduction during the study period. Dabigatran treatment, higher age at inclusion, high CHA 2 DS 2 -VASc score, and high HAS-BLED score were related to higher risk of dose reduction. Baseline ischemic heart disease (IHD), heart failure, cancer, CKD, chronic obstructive pulmonale disease (COPD), and hypertension were independent predictors of dose reduction. In subgroup analysis with six-month follow-up, MI/PCI, CKD, intracranial hemorrhage, peripheral bleeding, and antiplatelet treatment therapy were strongly associated with dose reduction. Conclusions: Dose reduction of NOACs was observed in 12.2% of AF patients during 2011–2017 and was associated with dabigatran treatment, advanced age at baseline, high CHA 2 DS 2 -VASc score, and high HAS-BLED score. Among comorbidities, IHD, heart failure, cancer, CKD, COPD, and hypertension predicted dose reduction independently. During six-month follow-up, MI/PCI showed the strongest association with dose reduction.

AB - Introduction: To investigate the patterns of dose reduction of non-vitamin K antagonist oral anticoagulants (NOAC) in patients with atrial fibrillation (AF). Materials and methods: Using Danish nationwide registries, we identified all non-valvular AF patients initiated on standard-dose NOAC during 2011–2017 who were followed until dose reduction. The absolute risk of dose reduction was presented as cumulative incidence both overall and according to baseline characteristics. Moreover, to assess baseline comorbidities related to dose reduction, adjusted Cox regression models were used. In subgroup analysis, we investigated dose reduction following acute myocardial infarction and/or percutaneous coronary intervention (MI/PCI), chronic kidney disease (CKD), turned 80 years, intracranial hemorrhage, peripheral bleeding, ischemic stroke, cancer, bone fracture, and antiplatelet treatment start. Results: Of 24,489 patients included, 12.2% experienced dose reduction during the study period. Dabigatran treatment, higher age at inclusion, high CHA 2 DS 2 -VASc score, and high HAS-BLED score were related to higher risk of dose reduction. Baseline ischemic heart disease (IHD), heart failure, cancer, CKD, chronic obstructive pulmonale disease (COPD), and hypertension were independent predictors of dose reduction. In subgroup analysis with six-month follow-up, MI/PCI, CKD, intracranial hemorrhage, peripheral bleeding, and antiplatelet treatment therapy were strongly associated with dose reduction. Conclusions: Dose reduction of NOACs was observed in 12.2% of AF patients during 2011–2017 and was associated with dabigatran treatment, advanced age at baseline, high CHA 2 DS 2 -VASc score, and high HAS-BLED score. Among comorbidities, IHD, heart failure, cancer, CKD, COPD, and hypertension predicted dose reduction independently. During six-month follow-up, MI/PCI showed the strongest association with dose reduction.

KW - Apixaban

KW - Atrial fibrillation

KW - Dabigatran

KW - Dose reduction

KW - NOAC

KW - Rivaroxaban

U2 - 10.1016/j.thromres.2019.04.007

DO - 10.1016/j.thromres.2019.04.007

M3 - Journal article

C2 - 31004965

AN - SCOPUS:85064265766

VL - 178

SP - 101

EP - 109

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

ER -