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Safety and Effectiveness of Oral Anticoagulants in Atrial Fibrillation: Real-World Insights Using Natural Language
Juan Cosín-Sales1,2, Manuel Anguita Sánchez3,4,5, Carmen Suárez6,7,8
1Cardiology Department, Arnau de Vilanova Hospital, 46015 Valencia, Spain.
Journal of Clinical Medicine
|October 26, 2024
Summary
Direct oral anticoagulants (DOACs) demonstrated superior safety and effectiveness compared to vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients. This real-world evidence, derived from artificial intelligence analysis of electronic health records, supports DOACs in complex patient populations.
Area of Science:
- Cardiology and Pharmaceutical Sciences
- Health Informatics and Artificial Intelligence
Background:
- Atrial fibrillation (AF) management requires effective anticoagulation to prevent thromboembolic events.
- Vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) are primary therapeutic options, necessitating comparative effectiveness and safety studies.
- Real-world data analysis using advanced computational techniques can provide valuable insights into treatment outcomes in diverse patient groups.
Purpose of the Study:
- To compare the effectiveness and safety of VKAs versus DOACs in adult patients with atrial fibrillation.
- To leverage artificial intelligence, including natural language processing (NLP) and machine learning (ML), for data extraction and analysis from electronic health records (EHRs).
- To evaluate outcomes such as thrombotic events, bleeding, and hospital mortality in a large, real-world cohort.
Main Methods:
- Retrospective study utilizing EHR data from 15 Spanish hospitals (2014-2020).
- EHRead® technology with NLP and ML, alongside SNOMED-CT terminology, for clinical data extraction.
- Propensity score matching (PSM) to create comparable cohorts for VKA and DOAC users, followed by Kaplan-Meier and Cox regression analyses.
Main Results:
- Analysis included 44,292 AF patients, with 79.6% on VKAs and 20.4% on DOACs, many elderly with significant comorbidities.
- After PSM, DOAC users exhibited a statistically significant lower risk of thrombotic events (HR 0.81), minor bleeding (HR 0.89), and mortality (HR 0.80).
- The study successfully applied AI techniques to generate real-world evidence on anticoagulation in a complex AF population.
Conclusions:
- The application of NLP and ML in EHRs provided valuable real-world evidence for anticoagulated AF patients in Spain.
- DOACs demonstrated a superior safety and effectiveness profile compared to VKAs, even in patients with complex clinical profiles.
- These findings support the use of DOACs as a preferred anticoagulant strategy in a broad range of AF patients.
Keywords:
atrial fibrillationdirect oral anticoagulantsnatural language processing and machine learningoral anticoagulationvitamin K antagonistMore Related Videos
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