Initiation of anticoagulation in atrial fibrillation: which factors are associated with choice of anticoagulant?. (30th May 2017)

• Record Type: Journal Article
• Authors: Gundlund, A.; Staerk, L.; Fosbøl, E. L.; Gadsbøll, K.; Sindet‐Pedersen, C.; Bonde, A. N.; Gislason, G. H.; Olesen, J. B.
• Is Part Of: Journal of internal medicine. Volume 282:Number 2(2017)
• Page Start: 164
• Page End: 174
• Publication Date: 2017-05-30
• Subjects: apixaban -- comorbidity -- dabigatran -- demography -- rivaroxaban -- warfarin; Internal medicine -- Periodicals; Medicine -- Periodicals; 616
• DOI: 10.1111/joim.12628
• Languages: English
• ISSNs: 0954-6820

Abstract

Abstract: Background: The use of non‐vitamin K antagonist oral anticoagulants (NOACs) for stroke prophylaxis in atrial fibrillation (AF) is increasing rapidly. We compared characteristics of AF patients initiated on NOACs versus vitamin K antagonists (VKAs). Methods: Using Danish nationwide registry data, we identified AF patients initiating either a VKA or a NOAC from 22 August 2011 until 30 September 2016. We compared patient characteristics including age, gender, comorbidities, concomitant pharmacotherapy and CHA2 DS2 ‐VASc and HAS‐BLED scores in patients initiated on a VKA, dabigatran, rivaroxaban or apixaban. Differences were examined using multivariable logistic regression models. Results: The study population comprised 51 981 AF patients of whom 19 989 (38.5%) were initiated on a VKA, 13 242 (25.5%) on dabigatran, 8475 (16.3%) on rivaroxaban and 10 275 (19.8%) on apixaban. Those patients initiated on apixaban had higher mean ± SD CHA2 DS2 ‐VASc scores than those initiated on a VKA (3.1 ± 1.6 vs. 2.9 ± 1.6). Those initiated on dabigatran had lower mean CHA2 DS2 ‐VASc scores (2.7 ± 1.6) than all other groups. Patients with a history of a prior stroke were significantly more likely to be initiated on a NOAC compared with a VKA [odds ratio (OR) 1.35, 95% confidence interval (CI) 1.28–1.43]. By contrast, patients with a history of myocardial infarction were less likely to be initiated on a NOAC compared with a VKA (OR 0.72, 95% CI 0.67–0.77). Conclusions: Atrial fibrillation patients who were initiated on apixaban had higher stroke risk scores than patients initiated on VKAs. Interestingly, opposite results were found for dabigatran.