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Initiation of anticoagulation in atrial fibrillation: which factors are associated with choice of anticoagulant?
Gundlund, A; Staerk, L; Fosbøl, E L; Gadsbøll, K; Sindet-Pedersen, C; Bonde, A N; Gislason, G H; Olesen, J B.
Afiliación
  • Gundlund A; Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.
  • Staerk L; Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.
  • Fosbøl EL; Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.
  • Gadsbøll K; Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
  • Sindet-Pedersen C; The Danish Heart Foundation, Rigshospitalet, Copenhagen, Denmark.
  • Bonde AN; Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.
  • Gislason GH; Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.
  • Olesen JB; Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.
J Intern Med ; 282(2): 164-174, 2017 08.
Article en En | MEDLINE | ID: mdl-28480507
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Accidente Cerebrovascular / Anticoagulantes Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: J Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2017 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Reino Unido
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Accidente Cerebrovascular / Anticoagulantes Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: J Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2017 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Reino Unido