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Published on: February 28, 2012
Oral Anticoagulant Use in Patients with Atrial Fibrillation at Low Risk of Stroke and Associated Bleeding
Adane Teshome Kefale1, Woldesellassie M Bezabhe1, Gregory M Peterson1
1School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia.
Insights
One in four low-risk atrial fibrillation patients received oral anticoagulants (OACs), with older age and newer OACs increasing prescription rates. OAC use did not raise bleeding risk compared to non-users.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Oral anticoagulants (OACs) may pose more harm than benefit for atrial fibrillation (AF) patients with low stroke risk.
- Prevalence and consequences of OAC use in this population are understudied.
Purpose of the Study:
- Investigate OAC prescription rates in low-risk AF patients.
- Identify factors associated with OAC prescription.
- Describe incident bleeding events in this cohort.
Main Methods:
- Retrospective analysis of Australian general practice data (2011-2018).
- Included new AF diagnoses with low stroke risk (CHA 2 DS 2 -VASc score 0 for males, 1 for females).
- Logistic regression for associated factors; propensity score matching for bleeding risk comparison.
Main Results:
- 25.1% of 2810 low-risk AF patients received OACs within 60 days of diagnosis.
- Older age and later diagnosis periods (post-2014) increased OAC odds.
- Female sex, higher bleeding risk (ORBIT), and higher socioeconomic status were associated with lower OAC odds.
- Bleeding rates were similar between OAC users and non-users post-matching, but OAC initiation increased bleeding risk within users.
Conclusions:
- OACs are prescribed to one in four low-risk AF patients.
- OAC prescription is linked to older age and the availability of newer direct-acting agents.
- While OAC use did not increase overall bleeding risk compared to non-use, initiation was associated with increased bleeding within users.
Background:
The use of oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and low stroke risk might cause more harm than benefit. Little attention has been given to address its prevalence and associated consequences. This study aimed to investigate the prescription rate of OACs, identify associated factors, and describe incident bleeding events in low-risk patients.
Methods:
We included patients with a new diagnosis of AF between 1 January 2011 and 31 December 2018 having a low risk of stroke (CHA2DS2-VASc score of 0 for males and 1 for females) from Australian general practice data (MedicineInsight). Patients were classified as OAC users if there was a recorded prescription of an OAC within 60 days of AF diagnosis, and factors associated with the prescription of an OAC were assessed using logistic regression. Recorded incident bleeding events were identified within 6 months after AF diagnosis or after OAC initiation for OAC non-users and users, respectively. The risk of bleeding was compared between the two groups by adjusting their baseline differences using propensity score matching.
Results:
The study included 2810 low-risk patients (62.3% male) with a mean age of 49.3 ± 10.8 years. Of the total, 705 (25.1%) patients had a record of OAC prescription within 60 days of diagnosis of AF. Older age (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.03-1.04) and diagnosis periods (2015-2016 [OR 1.46; 95% CI 1.10-1.94] and 2017-2018 [OR 1.65; 95% CI 1.17-2.23] vs. 2011-2012) were associated with higher odds of OAC initiation. Female sex (OR 0.71; 95% CI 0.59-0.85), higher bleeding risk (ORBIT score; OR 0.80; 95% CI 0.68-0.94), and higher socioeconomic index for areas (SEIFA) quintiles (SEIFA quintiles; 2 [OR 0.65; 95% CI 0.48-0.88], 3 [OR 0.74; 95% CI 0.56-0.98], 4 [OR 0.70; 95% CI 0.52-0.94], 5 [OR 0.69; 95% CI 0.52-0.91] compared with quintile 1) were associated with lower odds of OAC prescription. A total of 52 (in 1.8% of patients) incident bleeds were identified, with 18 (2.6%) among OAC users. The rate of bleeding was not significantly different between users and non-users after matching. However, within OAC users, commencement of OAC was associated with an increased risk of bleeding compared to the period before OAC initiation (p = 0.006).
Conclusions:
One in four patients at low risk of stroke received an OAC within 60 days of AF diagnosis. Older age and the period following the widespread availability of direct-acting OACs were associated with an increased likelihood of OAC prescription. Positively, using OACs was not associated with an increased rate of bleeding compared to non-users.
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