Oral anticoagulants in patients with atrial fibrillation at low stroke risk: a multicentre observational study.
Autor: | Komen JJ; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.; Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden., Pottegård A; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark., Mantel-Teeuwisse AK; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands., Forslund T; Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden.; Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden., Hjemdahl P; Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden., Wettermark B; Department of Pharmacy, Pharmacoepidemiology & Social Pharmacy, Uppsala University, Uppsala, Sweden., Hallas J; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark., Olesen M; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark., Bennie M; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.; Public Health Scotland, Edinburgh, UK., Mueller T; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK., Carragher R; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK., Karlstad Ø; Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway., Kjerpeseth LJ; Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway., Klungel OH; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark. |
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Jazyk: | angličtina |
Zdroj: | European heart journal [Eur Heart J] 2022 Oct 07; Vol. 43 (37), pp. 3528-3538. |
DOI: | 10.1093/eurheartj/ehac111 |
Abstrakt: | Aims: There is currently no consensus on whether atrial fibrillation (AF) patients at low risk for stroke (one non-sex-related CHA2DS2-VASc point) should be treated with an oral anticoagulant. Methods and Results: We conducted a multi-country cohort study in Sweden, Denmark, Norway, and Scotland. In total, 59 076 patients diagnosed with AF at low stroke risk were included. We assessed the rates of stroke or major bleeding during treatment with a non-vitamin K antagonist oral anticoagulant (NOAC), a vitamin K antagonist (VKA), or no treatment, using inverse probability of treatment weighted (IPTW) Cox regression. In untreated patients, the rate for ischaemic stroke was 0.70 per 100 person-years and the rate for a bleed was also 0.70 per 100 person-years. Comparing NOAC with no treatment, the stroke rate was lower [hazard ratio (HR) 0.72; 95% confidence interval (CI) 0.56-0.94], and the rate for intracranial haemorrhage (ICH) was not increased (HR 0.84; 95% CI 0.54-1.30). Comparing VKA with no treatment, the rate for stroke tended to be lower (HR 0.81; 95% CI 0.59-1.09), and the rate for ICH tended to be higher during VKA treatment (HR 1.37; 95% CI 0.88-2.14). Comparing NOAC with VKA treatment, the rate for stroke was similar (HR 0.92; 95% CI 0.70-1.22), but the rate for ICH was lower during NOAC treatment (HR 0.63; 95% CI 0.42-0.94). Conclusion: These observational data suggest that NOAC treatment may be associated with a positive net clinical benefit compared with no treatment or VKA treatment in patients at low stroke risk, a question that can be tested through a randomized controlled trial. Competing Interests: Conflict of interest: J.J.K. is currently employed by Daiichi-Sankyo, but not during the conduct of this study, and reports personal fees from Boehringer Ingelheim, outside the submitted work; A.P. reports grants from Alcon, grants from Almirall, grants from Astellas, grants from Astra-Zeneca, grants from Boehringer Ingelheim, grants from Novo Nordisk, grants from Servier, grants from LEO Pharma, outside the submitted work; Ø.K. reports participation in imposed Post-Authorization Safety Studies on an antidiabetic and an anti-psoriasis drug. The studies are funded by Leo Pharma and Novo Nordisk, with funds paid to the institution where he is employed (no personal fees) and with no relation to the work reported in this paper; L.J.K. was supported by the Research Council of Norway as part of the International Pregnancy Drug Safety Studies (InPreSS, Project No. 273366) during the conduct of the study. All other authors have nothing to declare. (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.) |
Databáze: | MEDLINE |
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