TY - JOUR

T1 - Predicted risk of stroke and bleeding and use of oral anticoagulants in atrial fibrillation

T2 - Danish nationwide temporal trends 2011–2016

AU - Dukanovic, Alexandar

AU - Staerk, Laila

AU - Fosbøl, Emil Loldrup

AU - Gadsbøll, Kasper

AU - Gislason, Gunnar Hilmar

AU - Olesen, Jonas Bjerring

PY - 2017/12

Y1 - 2017/12

N2 - Introduction, materials and methods We used Danish nationwide registries to examine temporal trends in the predicted stroke and bleeding risks (mean CHA2DS2-VASc and HAS-BLED scores per year, respectively) as well as the combination of selected stroke and bleeding risk factors per year among atrial fibrillation (AF) patients initiated for the first time between 2011 and 2016 on vitamin K antagonists (VKAs), dabigatran, rivaroxaban, or apixaban. Results In total, 53,860 AF patients were included (VKA 37.7%, dabigatran 24.4%, rivaroxaban 16.9%, apixaban 21.0%). For standard dose dabigatran initiators, during almost all of the study period, the mean CHA2DS2-VASc and HAS-BLED scores were the lowest and decreased (2.6 and 2.2 in 2011 vs. 2.1 and 1.8 in 2016, respectively). Reduced dose apixaban initiators had rather stable mean CHA2DS2-VASc scores during the study period and the highest mean CHA2DS2-VASc score in 2016 (4.1). The mean HAS-BLED scores were similarly high among reduced dose apixaban and rivaroxaban initiators in years 2013–2016. From 2011 to 2014, a decrease in the frequency of prior stroke (p < 0.001), age ≥ 75 years (p < 0.001), and prior bleeding (p = 0.007) was observed among dabigatran initiators. In the study period, apixaban initiators in general had the highest frequency of prior stroke and age ≥ 75 years. Conclusions Danish AF patients receiving standard dose dabigatran had the lowest and decreasing predicted stroke and bleeding risks during almost all study years. Patients receiving reduced dose apixaban had rather stable predicted risk of stroke during the study period and the highest mean CHA2DS2-VASc score in 2016.

AB - Introduction, materials and methods We used Danish nationwide registries to examine temporal trends in the predicted stroke and bleeding risks (mean CHA2DS2-VASc and HAS-BLED scores per year, respectively) as well as the combination of selected stroke and bleeding risk factors per year among atrial fibrillation (AF) patients initiated for the first time between 2011 and 2016 on vitamin K antagonists (VKAs), dabigatran, rivaroxaban, or apixaban. Results In total, 53,860 AF patients were included (VKA 37.7%, dabigatran 24.4%, rivaroxaban 16.9%, apixaban 21.0%). For standard dose dabigatran initiators, during almost all of the study period, the mean CHA2DS2-VASc and HAS-BLED scores were the lowest and decreased (2.6 and 2.2 in 2011 vs. 2.1 and 1.8 in 2016, respectively). Reduced dose apixaban initiators had rather stable mean CHA2DS2-VASc scores during the study period and the highest mean CHA2DS2-VASc score in 2016 (4.1). The mean HAS-BLED scores were similarly high among reduced dose apixaban and rivaroxaban initiators in years 2013–2016. From 2011 to 2014, a decrease in the frequency of prior stroke (p < 0.001), age ≥ 75 years (p < 0.001), and prior bleeding (p = 0.007) was observed among dabigatran initiators. In the study period, apixaban initiators in general had the highest frequency of prior stroke and age ≥ 75 years. Conclusions Danish AF patients receiving standard dose dabigatran had the lowest and decreasing predicted stroke and bleeding risks during almost all study years. Patients receiving reduced dose apixaban had rather stable predicted risk of stroke during the study period and the highest mean CHA2DS2-VASc score in 2016.

KW - Apixaban

KW - Atrial fibrillation

KW - Dabigatran

KW - Rivaroxaban

KW - Vitamin K antagonists

U2 - 10.1016/j.thromres.2017.10.010

DO - 10.1016/j.thromres.2017.10.010

M3 - Journal article

AN - SCOPUS:85032186534

VL - 160

SP - 19

EP - 26

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

ER -