Risk factors for stroke and choice of oral anticoagulant in atrial fibrillation

• Published in: European journal of clinical pharmacology 2018-12, Vol.74 (12), p.1653-1662
• Main Authors: Kjerpeseth, Lars J., Ellekjær, Hanne, Selmer, Randi, Ariansen, Inger, Furu, Kari, Skovlund, Eva
• Format: Article
• Language: English
• Subjects: Age; Age Factors; Aged; Aged, 80 and over; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Biomedical and Life Sciences; Biomedicine; Cardiac arrhythmia; Clinical Decision-Making; Congestive heart failure; Coronary artery disease; Dabigatran - adverse effects; Dabigatran - therapeutic use; Databases, Factual; Diabetes; Diabetes mellitus; Female; Fibrillation; Health risks; Heart failure; Humans; Ischemia; Male; Norway - epidemiology; Pharmacoepidemiology and Prescription; Pharmacology/Toxicology; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Pyrazoles - adverse effects; Pyrazoles - therapeutic use; Pyridones - adverse effects; Pyridones - therapeutic use; Registries; Risk Factors; Rivaroxaban - adverse effects; Rivaroxaban - therapeutic use; Sex Factors; Stroke; Stroke - epidemiology; Stroke - etiology; Thromboembolism; Transient ischemic attack; Vascular diseases; Warfarin
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-018-2540-3

Purpose To investigate risk factors for stroke in patients initiating oral anticoagulants for atrial fibrillation in Norway and their association with receiving DOACs versus warfarin. Methods From nationwide registries, we identified naïve users initiating treatment with warfarin, dabigatran, rivaroxaban, or apixaban for atrial fibrillation from 2010 to 2015 in Norway. We studied temporal changes in the CHA 2 DS 2 -VASc score and its component risk factors. We used multiple logistic regressions to identify CHA 2 DS 2 -VASc risk factors associated with receiving DOACs versus warfarin in 2015. Results From 2010 to 2015, the yearly number of new oral anticoagulant users increased from 7588 to 13,344. All new users initiated warfarin in 2010, while 86% initiated a DOAC in 2015. The mean CHA 2 DS 2 -VASc score decreased from 3.2 (SD 1.7) to 3.1 (SD 1.6) in the same period. Vascular disease (0.56 [0.49–0.63]), congestive heart failure (OR 0.65 [95% CI 0.58–0.72]), and diabetes (0.83 [0.73–0.95]) decreased the odds of receiving DOACs instead of warfarin, and ischemic stroke/transient ischemic attack/arterial thromboembolism (1.31 [1.12–1.54]), age 65–74 (1.23 [1.06–1.43]), and female sex (1.22 [1.10–1.36]) increased it. Age ≥ 75 (reference age