Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: Contemporary findings in real-life Danish patients

Morten Lamberts; Laila Staerk; Jonas Bjerring Olesen; Emil Loldrup Fosbøl; Morten Lock Hansen; Louise Harboe; Cinira Lefevre; David Evans; Gunnar Hilmar Gislason

doi:10.1161/JAHA.116.004517

Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: Contemporary findings in real-life Danish patients

Morten Lamberts^*, Laila Staerk, Jonas Bjerring Olesen, Emil Loldrup Fosbøl, Morten Lock Hansen, Louise Harboe, Cinira Lefevre, David Evans, Gunnar Hilmar Gislason

^*Corresponding author af dette arbejde

61 Citationer (Scopus)

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Abstract

Background-The nonvitamin K antagonist oral anticoagulants have recently become available as an alternative to warfarin as stroke prophylaxis in atrial fibrillation, but data on real-life patient experience, including bleeding risk, are lacking. Our objective was to compare major bleeding events and nonpersistence between the nonvitamin K antagonist oral anticoagulant apixaban and other nonvitamin K antagonist oral anticoagulants (dabigatran and rivaroxaban) and warfarin in a contemporary, nation-wide cohort of patients with nonvalvular atrial fibrillation. Methods and Results-Of 54 321 patients (median age, 73 years; 56% male; mean CHA₂DS₂-VASc score, 2.9), 7963, 6715, 15 413, and 24 230 patients initiated apixaban, rivaroxaban, dabigatran, and warfarin, respectively. Apixaban and rivaroxaban initiators were older, less often male, with higher HAS-BLED and CHA₂DS₂-VASc scores compared with dabigatran and warfarin initiators. A total of 2418 patients (4.5%) experienced a major bleeding event over all available follow-up. In this period, rivaroxaban (hazard ratio [HR] [95% CI], 1.49 [1.27-1.77]), dabigatran (HR, 1.17 [1.00-1.38]), and warfarin (HR, 1.23 [1.05-1.43]) users were significantly more likely to bleed than apixaban users. Findings were similar when restricted to the first 30 days after OAC initiation. Risk of nonpersistence was higher for dabigatran (HR, 1.45 [1.33-1.59]) and warfarin initiators (HR, 1.22 [1.12-1.33]), but not for rivaroxaban initiators (HR, 1.07 [0.96-1.20]) compared with apixaban initiators. Conclusions-In a real-world cohort of nonvalvular atrial fibrillation patients, apixaban had a lower adjusted major bleeding risk compared with rivaroxaban, dabigatran, and warfarin. Apixaban had a lower risk of nonpersistence compared with dabigatran and warfarin and similar risk compared with rivaroxaban.

Originalsprog	Engelsk
Artikelnummer	e004517
Tidsskrift	Journal of the American Heart Association
Vol/bind	6
Udgave nummer	2
Antal sider	14
ISSN	2047-9980
DOI	https://doi.org/10.1161/JAHA.116.004517
Status	Udgivet - feb. 2017

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10.1161/JAHA.116.004517Licens: CC BY-NC-ND

Major Bleeding Complications and Persistence With Oral Anticoagulation in Non-Valvular Atrial FibrillationForlagets udgivne version, 1,32 MBLicens: CC BY-NC-ND

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Lamberts, M., Staerk, L., Olesen, J. B., Fosbøl, E. L., Hansen, M. L., Harboe, L., Lefevre, C., Evans, D., & Gislason, G. H. (2017). Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: Contemporary findings in real-life Danish patients. Journal of the American Heart Association, 6(2), [e004517]. https://doi.org/10.1161/JAHA.116.004517

Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation : Contemporary findings in real-life Danish patients. / Lamberts, Morten; Staerk, Laila; Olesen, Jonas Bjerring et al.

I: Journal of the American Heart Association, Bind 6, Nr. 2, e004517, 02.2017.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Lamberts, M, Staerk, L, Olesen, JB, Fosbøl, EL, Hansen, ML, Harboe, L, Lefevre, C, Evans, D & Gislason, GH 2017, 'Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: Contemporary findings in real-life Danish patients', Journal of the American Heart Association, bind 6, nr. 2, e004517. https://doi.org/10.1161/JAHA.116.004517

@article{479a88ab64934217aa26d613aad1408f,

title = "Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: Contemporary findings in real-life Danish patients",

abstract = "Background-The nonvitamin K antagonist oral anticoagulants have recently become available as an alternative to warfarin as stroke prophylaxis in atrial fibrillation, but data on real-life patient experience, including bleeding risk, are lacking. Our objective was to compare major bleeding events and nonpersistence between the nonvitamin K antagonist oral anticoagulant apixaban and other nonvitamin K antagonist oral anticoagulants (dabigatran and rivaroxaban) and warfarin in a contemporary, nation-wide cohort of patients with nonvalvular atrial fibrillation. Methods and Results-Of 54 321 patients (median age, 73 years; 56% male; mean CHA2DS2-VASc score, 2.9), 7963, 6715, 15 413, and 24 230 patients initiated apixaban, rivaroxaban, dabigatran, and warfarin, respectively. Apixaban and rivaroxaban initiators were older, less often male, with higher HAS-BLED and CHA2DS2-VASc scores compared with dabigatran and warfarin initiators. A total of 2418 patients (4.5%) experienced a major bleeding event over all available follow-up. In this period, rivaroxaban (hazard ratio [HR] [95% CI], 1.49 [1.27-1.77]), dabigatran (HR, 1.17 [1.00-1.38]), and warfarin (HR, 1.23 [1.05-1.43]) users were significantly more likely to bleed than apixaban users. Findings were similar when restricted to the first 30 days after OAC initiation. Risk of nonpersistence was higher for dabigatran (HR, 1.45 [1.33-1.59]) and warfarin initiators (HR, 1.22 [1.12-1.33]), but not for rivaroxaban initiators (HR, 1.07 [0.96-1.20]) compared with apixaban initiators. Conclusions-In a real-world cohort of nonvalvular atrial fibrillation patients, apixaban had a lower adjusted major bleeding risk compared with rivaroxaban, dabigatran, and warfarin. Apixaban had a lower risk of nonpersistence compared with dabigatran and warfarin and similar risk compared with rivaroxaban.",

keywords = "Anticoagulant, Atrial fibrillation, Bleeding",

author = "Morten Lamberts and Laila Staerk and Olesen, {Jonas Bjerring} and Fosb{\o}l, {Emil Loldrup} and Hansen, {Morten Lock} and Louise Harboe and Cinira Lefevre and David Evans and Gislason, {Gunnar Hilmar}",

year = "2017",

month = feb,

doi = "10.1161/JAHA.116.004517",

language = "English",

volume = "6",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley-Blackwell",

number = "2",

}

TY - JOUR

T1 - Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation

T2 - Contemporary findings in real-life Danish patients

AU - Lamberts, Morten

AU - Staerk, Laila

AU - Olesen, Jonas Bjerring

AU - Fosbøl, Emil Loldrup

AU - Hansen, Morten Lock

AU - Harboe, Louise

AU - Lefevre, Cinira

AU - Evans, David

AU - Gislason, Gunnar Hilmar

PY - 2017/2

Y1 - 2017/2

N2 - Background-The nonvitamin K antagonist oral anticoagulants have recently become available as an alternative to warfarin as stroke prophylaxis in atrial fibrillation, but data on real-life patient experience, including bleeding risk, are lacking. Our objective was to compare major bleeding events and nonpersistence between the nonvitamin K antagonist oral anticoagulant apixaban and other nonvitamin K antagonist oral anticoagulants (dabigatran and rivaroxaban) and warfarin in a contemporary, nation-wide cohort of patients with nonvalvular atrial fibrillation. Methods and Results-Of 54 321 patients (median age, 73 years; 56% male; mean CHA2DS2-VASc score, 2.9), 7963, 6715, 15 413, and 24 230 patients initiated apixaban, rivaroxaban, dabigatran, and warfarin, respectively. Apixaban and rivaroxaban initiators were older, less often male, with higher HAS-BLED and CHA2DS2-VASc scores compared with dabigatran and warfarin initiators. A total of 2418 patients (4.5%) experienced a major bleeding event over all available follow-up. In this period, rivaroxaban (hazard ratio [HR] [95% CI], 1.49 [1.27-1.77]), dabigatran (HR, 1.17 [1.00-1.38]), and warfarin (HR, 1.23 [1.05-1.43]) users were significantly more likely to bleed than apixaban users. Findings were similar when restricted to the first 30 days after OAC initiation. Risk of nonpersistence was higher for dabigatran (HR, 1.45 [1.33-1.59]) and warfarin initiators (HR, 1.22 [1.12-1.33]), but not for rivaroxaban initiators (HR, 1.07 [0.96-1.20]) compared with apixaban initiators. Conclusions-In a real-world cohort of nonvalvular atrial fibrillation patients, apixaban had a lower adjusted major bleeding risk compared with rivaroxaban, dabigatran, and warfarin. Apixaban had a lower risk of nonpersistence compared with dabigatran and warfarin and similar risk compared with rivaroxaban.

AB - Background-The nonvitamin K antagonist oral anticoagulants have recently become available as an alternative to warfarin as stroke prophylaxis in atrial fibrillation, but data on real-life patient experience, including bleeding risk, are lacking. Our objective was to compare major bleeding events and nonpersistence between the nonvitamin K antagonist oral anticoagulant apixaban and other nonvitamin K antagonist oral anticoagulants (dabigatran and rivaroxaban) and warfarin in a contemporary, nation-wide cohort of patients with nonvalvular atrial fibrillation. Methods and Results-Of 54 321 patients (median age, 73 years; 56% male; mean CHA2DS2-VASc score, 2.9), 7963, 6715, 15 413, and 24 230 patients initiated apixaban, rivaroxaban, dabigatran, and warfarin, respectively. Apixaban and rivaroxaban initiators were older, less often male, with higher HAS-BLED and CHA2DS2-VASc scores compared with dabigatran and warfarin initiators. A total of 2418 patients (4.5%) experienced a major bleeding event over all available follow-up. In this period, rivaroxaban (hazard ratio [HR] [95% CI], 1.49 [1.27-1.77]), dabigatran (HR, 1.17 [1.00-1.38]), and warfarin (HR, 1.23 [1.05-1.43]) users were significantly more likely to bleed than apixaban users. Findings were similar when restricted to the first 30 days after OAC initiation. Risk of nonpersistence was higher for dabigatran (HR, 1.45 [1.33-1.59]) and warfarin initiators (HR, 1.22 [1.12-1.33]), but not for rivaroxaban initiators (HR, 1.07 [0.96-1.20]) compared with apixaban initiators. Conclusions-In a real-world cohort of nonvalvular atrial fibrillation patients, apixaban had a lower adjusted major bleeding risk compared with rivaroxaban, dabigatran, and warfarin. Apixaban had a lower risk of nonpersistence compared with dabigatran and warfarin and similar risk compared with rivaroxaban.

KW - Anticoagulant

KW - Atrial fibrillation

KW - Bleeding

U2 - 10.1161/JAHA.116.004517

DO - 10.1161/JAHA.116.004517

M3 - Journal article

C2 - 28196815

AN - SCOPUS:85015983099

SN - 2047-9980

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 2

M1 - e004517

ER -

Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: Contemporary findings in real-life Danish patients

Abstract

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