Trends in warfarin use and its associations with thromboembolic and bleeding rates in a population with atrial fibrillation between 1996 and 2011

Peter Wæde Hansen; Thomas S G Sehested; Emil Loldrup Fosbøl; Christian Torp-Pedersen; Lars Køber; Charlotte Andersson; Gunnar H Gislason

doi:10.1371/journal.pone.0194295

Trends in warfarin use and its associations with thromboembolic and bleeding rates in a population with atrial fibrillation between 1996 and 2011

Peter Wæde Hansen, Thomas S G Sehested, Emil Loldrup Fosbøl, Christian Torp-Pedersen, Lars Køber, Charlotte Andersson, Gunnar H Gislason

Institut for Klinisk Medicin

7 Citationer (Scopus)

44 Downloads (Pure)

Abstract

Aim Warfarin is a cornerstone for the prevention of thromboembolism in atrial fibrillation (AF), and several efforts have been taken to increase its usage and safety, including risk stratification schemes. Our aim was to investigate the temporal trends in initiation of warfarin and its effects on incidence of bleeding and thromboembolism in patients with new-onset atrial fibrillation 1996-2011. Methods All patients with a first-Time diagnosis of non-valvular atrial fibrillation were identified from nationwide administrative registries. Trends were determined by linear regression. Results In total 153,682 patients were included. Initiation of warfarin increased from 14% to 41% (p<0.0001). Events of thromboembolism decreased from 3.9% to 2.6% annually (p<0.0001). The greatest decline in thromboembolic events was observed for patients with a CHA₂DS₂VASc score >1, where the annual decline was -0.12% (95%CI: -0.161; -0.084)) for those treated with warfarin and -0.073% (95%CI: -0.116;-0.030)) for those not treated with warfarin. Bleeding increased from 3.3% to 3.9% (p = 0.043). For those with a CHA₂DS₂- VASc score >1 annual bleeding rates increased by 0.095% (95%CI: -0.025; -0.165) in warfarin treated and by 0.056% (95%CI: -0.013; -0.100) in patients not treated with warfarin. Conclusion Warfarin use increased by nearly a 3-fold between 1996 and 2011. During the same period, thromboembolic events declined by a third and bleeding increased by a fifth, suggesting a beneficial effect associated with higher warfarin use. Notably, a small decline in thromboembolic events and increase in bleeding events was observed for the untreated population, suggesting a changing risk profile of AF patients.

Originalsprog	Engelsk
Artikelnummer	e0194295
Tidsskrift	PLoS ONE
Vol/bind	13
Udgave nummer	3
Antal sider	14
ISSN	1932-6203
DOI	https://doi.org/10.1371/journal.pone.0194295
Status	Udgivet - mar. 2018

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10.1371/journal.pone.0194295Licens: CC BY

journal.pone.0194295Forlagets udgivne version, 2,4 MBLicens: CC BY

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title = "Trends in warfarin use and its associations with thromboembolic and bleeding rates in a population with atrial fibrillation between 1996 and 2011",

abstract = "Aim Warfarin is a cornerstone for the prevention of thromboembolism in atrial fibrillation (AF), and several efforts have been taken to increase its usage and safety, including risk stratification schemes. Our aim was to investigate the temporal trends in initiation of warfarin and its effects on incidence of bleeding and thromboembolism in patients with new-onset atrial fibrillation 1996-2011. Methods All patients with a first-Time diagnosis of non-valvular atrial fibrillation were identified from nationwide administrative registries. Trends were determined by linear regression. Results In total 153,682 patients were included. Initiation of warfarin increased from 14% to 41% (p<0.0001). Events of thromboembolism decreased from 3.9% to 2.6% annually (p<0.0001). The greatest decline in thromboembolic events was observed for patients with a CHA2DS2VASc score >1, where the annual decline was -0.12% (95%CI: -0.161; -0.084)) for those treated with warfarin and -0.073% (95%CI: -0.116;-0.030)) for those not treated with warfarin. Bleeding increased from 3.3% to 3.9% (p = 0.043). For those with a CHA2DS2- VASc score >1 annual bleeding rates increased by 0.095% (95%CI: -0.025; -0.165) in warfarin treated and by 0.056% (95%CI: -0.013; -0.100) in patients not treated with warfarin. Conclusion Warfarin use increased by nearly a 3-fold between 1996 and 2011. During the same period, thromboembolic events declined by a third and bleeding increased by a fifth, suggesting a beneficial effect associated with higher warfarin use. Notably, a small decline in thromboembolic events and increase in bleeding events was observed for the untreated population, suggesting a changing risk profile of AF patients.",

keywords = "Aged, Aged, 80 and over, Anticoagulants/adverse effects, Atrial Fibrillation/complications, Comorbidity, Denmark/epidemiology, Hemorrhage/epidemiology, History, 20th Century, History, 21st Century, Humans, Middle Aged, Platelet Aggregation Inhibitors/adverse effects, Population Surveillance, Registries, Thromboembolism/epidemiology, Warfarin/adverse effects",

author = "Hansen, {Peter W{\ae}de} and Sehested, {Thomas S G} and Fosb{\o}l, {Emil Loldrup} and Christian Torp-Pedersen and Lars K{\o}ber and Charlotte Andersson and Gislason, {Gunnar H}",

year = "2018",

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doi = "10.1371/journal.pone.0194295",

language = "English",

volume = "13",

journal = "PLoS Computational Biology",

issn = "1932-6203",

publisher = "Public Library of Science",

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TY - JOUR

T1 - Trends in warfarin use and its associations with thromboembolic and bleeding rates in a population with atrial fibrillation between 1996 and 2011

AU - Hansen, Peter Wæde

AU - Sehested, Thomas S G

AU - Fosbøl, Emil Loldrup

AU - Torp-Pedersen, Christian

AU - Køber, Lars

AU - Andersson, Charlotte

AU - Gislason, Gunnar H

PY - 2018/3

Y1 - 2018/3

N2 - Aim Warfarin is a cornerstone for the prevention of thromboembolism in atrial fibrillation (AF), and several efforts have been taken to increase its usage and safety, including risk stratification schemes. Our aim was to investigate the temporal trends in initiation of warfarin and its effects on incidence of bleeding and thromboembolism in patients with new-onset atrial fibrillation 1996-2011. Methods All patients with a first-Time diagnosis of non-valvular atrial fibrillation were identified from nationwide administrative registries. Trends were determined by linear regression. Results In total 153,682 patients were included. Initiation of warfarin increased from 14% to 41% (p<0.0001). Events of thromboembolism decreased from 3.9% to 2.6% annually (p<0.0001). The greatest decline in thromboembolic events was observed for patients with a CHA2DS2VASc score >1, where the annual decline was -0.12% (95%CI: -0.161; -0.084)) for those treated with warfarin and -0.073% (95%CI: -0.116;-0.030)) for those not treated with warfarin. Bleeding increased from 3.3% to 3.9% (p = 0.043). For those with a CHA2DS2- VASc score >1 annual bleeding rates increased by 0.095% (95%CI: -0.025; -0.165) in warfarin treated and by 0.056% (95%CI: -0.013; -0.100) in patients not treated with warfarin. Conclusion Warfarin use increased by nearly a 3-fold between 1996 and 2011. During the same period, thromboembolic events declined by a third and bleeding increased by a fifth, suggesting a beneficial effect associated with higher warfarin use. Notably, a small decline in thromboembolic events and increase in bleeding events was observed for the untreated population, suggesting a changing risk profile of AF patients.

AB - Aim Warfarin is a cornerstone for the prevention of thromboembolism in atrial fibrillation (AF), and several efforts have been taken to increase its usage and safety, including risk stratification schemes. Our aim was to investigate the temporal trends in initiation of warfarin and its effects on incidence of bleeding and thromboembolism in patients with new-onset atrial fibrillation 1996-2011. Methods All patients with a first-Time diagnosis of non-valvular atrial fibrillation were identified from nationwide administrative registries. Trends were determined by linear regression. Results In total 153,682 patients were included. Initiation of warfarin increased from 14% to 41% (p<0.0001). Events of thromboembolism decreased from 3.9% to 2.6% annually (p<0.0001). The greatest decline in thromboembolic events was observed for patients with a CHA2DS2VASc score >1, where the annual decline was -0.12% (95%CI: -0.161; -0.084)) for those treated with warfarin and -0.073% (95%CI: -0.116;-0.030)) for those not treated with warfarin. Bleeding increased from 3.3% to 3.9% (p = 0.043). For those with a CHA2DS2- VASc score >1 annual bleeding rates increased by 0.095% (95%CI: -0.025; -0.165) in warfarin treated and by 0.056% (95%CI: -0.013; -0.100) in patients not treated with warfarin. Conclusion Warfarin use increased by nearly a 3-fold between 1996 and 2011. During the same period, thromboembolic events declined by a third and bleeding increased by a fifth, suggesting a beneficial effect associated with higher warfarin use. Notably, a small decline in thromboembolic events and increase in bleeding events was observed for the untreated population, suggesting a changing risk profile of AF patients.

KW - Aged

KW - Aged, 80 and over

KW - Anticoagulants/adverse effects

KW - Atrial Fibrillation/complications

KW - Comorbidity

KW - Denmark/epidemiology

KW - Hemorrhage/epidemiology

KW - History, 20th Century

KW - History, 21st Century

KW - Humans

KW - Middle Aged

KW - Platelet Aggregation Inhibitors/adverse effects

KW - Population Surveillance

KW - Registries

KW - Thromboembolism/epidemiology

KW - Warfarin/adverse effects

U2 - 10.1371/journal.pone.0194295

DO - 10.1371/journal.pone.0194295

M3 - Journal article

C2 - 29547673

SN - 1932-6203

VL - 13

JO - PLoS Computational Biology

JF - PLoS Computational Biology

IS - 3

M1 - e0194295

ER -

Trends in warfarin use and its associations with thromboembolic and bleeding rates in a population with atrial fibrillation between 1996 and 2011

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