Real-world direct oral anticoagulant experience in atrial fibrillation: falls risk and low dose anticoagulation are predictive of both bleeding and stroke risk
| Autor: | Tanun Kitipornchai, Hui Yin Lim, Rowena Brook, Prahlad Ho, Oranut Aswapanyawongse, Mark Tacey |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Victoria medicine.drug_class Administration Oral 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Atrial Fibrillation Internal Medicine medicine Humans 030212 general & internal medicine Stroke Aged Retrospective Studies business.industry Anticoagulant Hazard ratio Anticoagulants Atrial fibrillation Vitamin K antagonist medicine.disease Thrombosis Clinical trial Accidental Falls business Discovery and development of direct thrombin inhibitors |
| Zdroj: | Internal medicine journalReferences. 50(11) |
| ISSN: | 1445-5994 |
| Popis: | Background Clinical trials have demonstrated that direct oral anticoagulants (DOAC) are non-inferior to vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation (AF) with comparable safety outcomes; however, real-world Australian data are limited. Aims To evaluate local real-world DOAC use focussing on safety, particularly in high-risk patients. Methods A retrospective evaluation of 658 patients commenced or continued on DOAC between September 2013 and September 2016 for non-valvular AF at Northern Hospital, a tertiary hospital in Victoria, Australia was performed. Results Factor Xa inhibitors were more commonly prescribed than direct thrombin inhibitors (83.3 vs 16.7%) for AF management. The median patient age was 75 years. The rate of clinically significant bleeding on anticoagulation was 3.13 per 100 person-years (including four deaths) with risk factors including history of bleeding (hazard ratio (HR) 3.52, 95% confidence interval (CI) 1.22-10.17), concurrent antiplatelet therapy (HR 2.62, 95% CI: 1.11-6.20) and high falls risk (HR 2.76, 95% CI: 1.26-6.08). Patients on low-dose DOAC had significantly higher bleeding risk compared with those on full dose (5.05 vs 1.82 per 100 person-years). The rate of thrombotic stroke despite anticoagulation was 1.34 per 100 person-years with risk factors including low dose anticoagulation (P = 0.034), high falls risk (P = 0.046) and previous stroke (P = 0.028). Conclusions DOAC use in real-world Australian practice is safe and effective, consistent with international data. Low dose anticoagulation and falls risk are associated with increased bleeding and thrombotic risk demonstrating overlapping risk factors. Careful individualised patient risk assessment is still required as low dose anticoagulation is not without risks. |
| Databáze: | OpenAIRE |
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