Advertisement
Original Article| Volume 33, P42-46, September 2016

Download started.

Ok

Vitamin K and non-vitamin K antagonist oral anticoagulants for non-valvular atrial fibrillation in real-life

Published:July 06, 2016DOI:https://doi.org/10.1016/j.ejim.2016.06.022
Vitamin K and non-vitamin K antagonist oral anticoagulants for non-valvular atrial fibrillation in real-life
Previous ArticleShort-term amiodarone treatment for atrial fibrillation after catheter ablation induces a transient thyroid dysfunction: Results from the placebo-controlled, randomized AMIO-CAT trial
Next ArticleClinical management and outcome of major bleeding in patients on treatment with vitamin K antagonists

      Highlights

      • •
        The patterns of “real world” usage of NOACs-patients were compared to VKAs-patients.
      • •
        NOAC agents were used in higher risk patients both for stroke and bleeding.
      • •
        Reduced dose of NOACs were prescribed in a large percentage of patients.

      Abstract

      Background

      Current guidelines recommend vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with non-valvular atrial fibrillation (AF).

      Methods

      We compared the clinical features of consecutive in- and out-patients with non-valvular AF newly-treated with NOACs or on treatment with VKAs.

      Results

      Overall, 1314 patients newly-treated with NOACs and 1024 on treatment with VKAs were included in the study. The mean CHA2DS2-VASc score was 4.3 ± 1.5 and 4.0 ± 1.5 and the mean HAS-BLED score was 2.8 ± 1.2 and 2.2 ± 1.1 in the two groups, respectively (both p < 0.001). Hypertension, previous stroke, female gender, vascular diseases and previous bleeding were more prevalent in NOACs patients. Renal failure, age ≥75 years and congestive heart failure were more prevalent in VKAs patients. Among NOACs patients, 438 were given dabigatran, 463 rivaroxaban and 413 apixaban (33%, 35% and 31%, respectively). The mean CHA2DS2-VASc and HAS-BLED scores were higher in rivaroxaban or apixaban patients compared with dabigatran (both p < 0.001) and VKAs patients (both p < 0.001). A lower mean age was observed in patients newly-treated with dabigatran. Patients newly-treated with reduced doses of NOACs (599 patients, 45.5%) had a higher CHA2DS2-VASc (4.8 ± 1.4 vs. 3.9 ± 1.5 vs. 4.0 ± 1.5) and HAS-BLED (2.9 ± 1.1 vs. 2.8 ± 1.2 vs. 2.2 ± 1.1) scores compared with those treated with regular doses of NOACs or VKAs.

      Conclusion

      Patients given rivaroxaban and apixaban in clinical practice have a higher thrombotic and hemorrhagic risk in comparison with patients given dabigatran or VKAs. A considerable proportion of patients receive reduced doses of NOACs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Camm A.J.
        • Kirchhof P.
        • Lip G.Y.
        • Schotten U.
        • Savelieva I.
        • Ernst S.
        • et al.
        Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).
        Europace. 2010; 12: 1360-1420
        View in Article
        • Miller P.S.J.
        • Andersson F.L.
        • Kalra L.
        Are cost benefits of anticoagulation for stroke prevention in atrial fibrillation underestimated?.
        Stroke. 2005; 36: 360-366
        View in Article
        • Patel M.R.
        • Mahaffey K.W.
        • Garg J.
        • Pan P.
        • Singer D.E.
        • Hacke W.
        • et al.
        Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.
        N Engl J Med. 2011; 365: 883-891
        View in Article
        • Connolly S.J.
        • Ezekowitz M.D.
        • Yusuf S.
        • Eikelboom J.
        • Oldgren J.
        • Parekh A.
        • et al.
        Dabigatran versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2009; 361: 1139-1151
        View in Article
        • Granger C.B.
        • Alexander J.H.
        • McMurray J.J.
        • Lopes R.D.
        • Hylek E.M.
        • Hanna M.
        • et al.
        Apixaban versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2011; 365: 981-992
        View in Article
        • Giugliano R.P.
        • Ruff C.T.
        • Braunwald E.
        • Murphy S.A.
        • Wiviott S.A.
        • Halperin J.L.
        • et al.
        Edoxaban versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2013; 369: 2093-2104
        View in Article
        • Camm A.J.
        • Lip G.Y.
        • De Caterina R.
        • Savelieva I.
        • Atar D.
        • Hohnloser S.H.
        • et al.
        2012 focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation.
        Eur Heart J. 2012; 33: 2719-2747https://doi.org/10.1093/eurheartj/ehs253
        View in Article
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        View in Article
        • Lip G.Y.
        • Nieuwlaat R.
        • Pisters R.
        • Lane D.A.
        • Crijms H.J.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation.
        Chest. 2010; 137: 263-272
        View in Article
        • Gage B.F.
        • Waterman A.D.
        • Shannon W.
        • Boechler M.
        • Rich M.W.
        • Radford M.J.
        Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation.
        JAMA. 2001; 285: 2864-2870
        View in Article
        • Pisters R.
        • Lane D.A.
        • Nieuwlaat R.
        • de Vos C.B.
        • Crijns H.J.
        • Lip G.Y.
        A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.
        Chest. 2010; 138: 1093-1100
        View in Article
        • Lip G.Y.
        • Laroche C.
        • Dan G.A.
        • Santini M.
        • Kalarus Z.
        • Rasmussen L.H.
        • et al.
        A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry.
        Europace. 2014 Mar; 16: 308-319https://doi.org/10.1093/europace/eut373
        View in Article
        • Olesen J.B.
        • Sørensen R.
        • Hansen M.L.
        • Lamberts M.
        • Weeke P.
        • Mikkelsen A.P.
        • et al.
        Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naïve atrial fibrillation patients: Danish nationwide descriptive data 2011–2013.
        Europace. 2015 Feb; 17: 187-193
        View in Article
        • Cullen M.W.
        • Kim S.
        • Piccini J.P.
        • Ansell J.E.
        • Fonarow G.C.
        • Hylek E.M.
        • et al.
        Risks and benefits of anticoagulation in atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
        Circ Cardiovasc Qual Outcomes. 2013; 6: 461-469
        View in Article
        • Steinberg B.A.
        • Blanco R.G.
        • Ollis D.
        • Kim S.
        • Holmes D.N.
        • Kowey P.R.
        • et al.
        Outcomes registry for better informed treatment of atrial fibrillation II: rationale and design of the ORBIT-AF II registry.
        Am Heart J. 2014 Aug; 168: 160-167https://doi.org/10.1016/j.ahj.2014.04.005
        View in Article
        • Beyer-Westendorf J.
        • Fo¨ rster K.
        • Pannach S.
        • Ebertz F.
        • Gelbricht V.
        • Thieme C.
        • et al.
        Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC Registry.
        Blood. 2014; 124: 955-962
        View in Article
        • Graham D.J.
        • Reichman M.E.
        • Wernecke M.
        • Zhang R.
        • Southworth M.R.
        • Levenson M.
        • et al.
        Cardiovascular, bleeding, and mortality risks in elderly Medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation.
        Circulation. 2015 Jan 13; 131: 157-164https://doi.org/10.1161/CIRCULATIONAHA.114.012061
        View in Article
        • Camm A.J.
        • Amarenco P.
        • Haas S.
        • Hess S.
        • Kirchhof P.
        • Kuhls S.
        • et al.
        XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation.
        Eur Heart J. 2016 Apr 7; 37: 1145-1153https://doi.org/10.1093/eurheartj/ehv466
        View in Article
        • Gussoni G.
        • Di Pasquale G.
        • Vescovo G.
        • Gulizia M.
        • Mathieu G.
        • Scherillo M.
        • et al.
        Decision making for oral anticoagulants in atrial fibrillation: the ATA-AF study.
        Eur J Intern Med. 2013 Jun; 24 ([Epub 2013 May 16]): 324-332https://doi.org/10.1016/j.ejim.2013.04.008
        View in Article
        • Hijazi Z.
        • Hohnloser S.H.
        • Oldgren J.
        • Andersson U.
        • Connolly S.J.
        • Eikelboom J.W.
        • et al.
        Efficacy and safety of dabigatran compared with warfarin in relation to baseline renal function in patients with atrial fibrillation: a RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) trial analysis.
        Circulation. Mar 4 2014; 129 ([Epub 2013 Dec 9]): 961-970https://doi.org/10.1161/CIRCULATIONAHA.113.003628
        View in Article
        • Eikelboom J.W.
        • Wallentin L.
        • Connolly S.J.
        • Ezekowitz M.
        • Healey J.S.
        • Oldgren J.
        • et al.
        Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial.
        Circulation. 2011; 123: 2363-2372
        View in Article

      Article info

      Publication history

      Published online: July 06, 2016
      Accepted: June 16, 2016
      Received in revised form: June 15, 2016
      Received: March 30, 2016

      Identification

      DOI: https://doi.org/10.1016/j.ejim.2016.06.022

      Copyright

      © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX