Ischaemic and haemorrhagic stroke associated with non-vitamin K antagonist oral anticoagulants and warfarin use in patients with atrial fibrillation: a nationwide cohort study

Stærk, Laila; Fosbøl, Emil Loldrup; Lip, Gregory Y.H.; Lamberts, Morten; Bonde, Anders; Torp‐Pedersen, Christian; Ozenne, Brice; Gerds, Thomas Alexander; Gislason, Gunnar; Olesen, Jonas Bjerring

doi:10.1093/eurheartj/ehw496

Cited by 70 publications

(91 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our group has previously published a study showing that dabigatran and apixaban were associated with lower risk of intracranial bleeding compared with VKA . In a perspective of previously published studies and the results from this study, dabigatran may have the lowest associated risk of intracranial bleeding compared with the other NOACs and VKA . In Denmark, dabigatran was selected in less than 10% amongst all first‐time users of OAC in December 2015 .…”

Section: Discussionmentioning

confidence: 78%

“…We compared standard dose of NOAC and reduced dose of NOAC in two separate cohorts to avoid implanting a major confounding by indication bias; however, the differential thresholds for NOAC dose reduction could influence the risks of outcomes. We have previously shown that amongst those receiving reduced dose NOAC, 66.2% were ≥80 years (dabigatran 61.3%, rivaroxaban 64.3% and apixaban 77.1%) . We do not have available data on body weight or blood tests in the Danish registries, and of that reason we could not examine if reduced dose was given according to guideline criteria.…”

Section: Discussionmentioning

confidence: 79%

“…Other comparative observational studies, including a recently published study from our group, have compared NOACs versus VKA, and the studies found no difference in the association between stroke risk and dabigatran, rivaroxaban or apixaban compared with VKA . In the present study, we extend our prior observations by showing that there was no absolute risk difference in the associated stroke risk between standard dose of NOAC or between reduced dose of NOAC.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Standard and reduced doses of dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation: a nationwide cohort study

et al. 2017

View full text Add to dashboard Cite

Background Comparative data of non‐vitamin K antagonist oral anticoagulants (NOAC) are lacking in patients with atrial fibrillation (AF). Objective We compared effectiveness and safety of standard and reduced dose NOAC in AF patients. Methods Using Danish nationwide registries, we included all oral anticoagulant‐naïve AF patients who initiated NOAC treatment (2012–2016). Outcome‐specific and mortality‐specific multiple Cox regressions were combined to compute average treatment effects as 1‐year standardized differences in stroke and bleeding risks (g‐formula). Results Amongst 31 522 AF patients, the distribution of NOAC/dose was as follows: dabigatran standard dose (22.4%), dabigatran‐reduced dose (14.0%), rivaroxaban standard dose (21.8%), rivaroxaban reduced dose (6.7%), apixaban standard dose (22.9%), and apixaban reduced dose (12.2%). The 1‐year standardized absolute risks of stroke/thromboembolism were 1.73–1.98% and 2.51–2.78% with standard and reduced NOAC dose, respectively, without statistically significant differences between NOACs for given dose level. Comparing standard doses, the 1‐year standardized absolute risk (95% CI) for major bleeding was for rivaroxaban 2.78% (2.42–3.17%); corresponding absolute risk differences (95% CI) were for dabigatran −0.93% (−1.45% to −0.38%) and apixaban, −0.54% (−0.99% to −0.05%). The results for major bleeding were similar for reduced NOAC dose. The 1‐year standardized absolute risk (95% CI) for intracranial bleeding was for standard dose dabigatran 0.19% (0.22–0.50%); corresponding absolute risk differences (95% CI) were for rivaroxaban 0.23% (0.06–0.41%) and apixaban, 0.18% (0.01–0.34%). Conclusions Standard and reduced dose NOACs, respectively, showed no significant risk difference for associated stroke/thromboembolism. Rivaroxaban was associated with higher bleeding risk compared with dabigatran and apixaban and dabigatran was associated with lower intracranial bleeding risk compared with rivaroxaban and apixaban.

show abstract

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Standard and reduced doses of dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation: a nationwide cohort study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Эта часто-та соответствует частоте инсультов, наблюдавшейся в других исследованиях с использованием антикоагулянтов у больных с мерцательной аритмией [20]. Различия оказа-лись недостоверны, учитывая достаточно небольшой объем наблюдаемой группы.…”

Section: обсуждение результатовunclassified

Experience in the Use of Oral Anticoagulants in Outpatient Clinics

Voskresenskaya¹,

Azizova²,

Zubritskaya³

et al. 2017

Med. sov.

View full text Add to dashboard Cite

“…Standardized absolute risk of stroke and for the intracranial bleeding outcome at 1 year after initiation of Vitamin K antagonist has been estimated in 2.01% and 0.60%, respectively [5]. On the other hand, taken into account the time with therapeutic range, it has been estimated that the average quality of anticoagulation is 60.5%, and a high percentage of patients have a quality of anticoagulation below recommended levels [6].…”

Section: Introductionmentioning

confidence: 99%

Should the Left Atrial Appendage Always be Removed in Mital Valve Surgery? In Search of a Perfect Outfit

Villarreal¹

2017

JCCR

View full text Add to dashboard Cite

Atrial fibrillation is the most common arrhythmia in worldwide. The left atrial appendage morphology with long body and narrow base, blood stasis and atrial fibrillation increase thrombi formation. Cardioembolic strokes are 17.9-fold more frequent in non-valvular atrial fibrillation patients than those without atrial fibrillation. The efficacy of chronic anticoagulation therapy to prevent ischemic strokes in atrial fibrillation is well established. Adjusted-dose warfarin reduces stroke by 60% and death by 25% compared with no antithrombotic treatment. Introduction of NOACs agents has help to increase the proportion of atrial fibrillation patients receiving anticoagulant therapy. However, despite demonstrated efficacy and professional guideline recommendations, oral anticoagulation treatment rates in patients with atrial fibrillation are generally below 60%. Left atrial appendage occlussion has now become the most preferred method of choice for reducing the possibility of stroke in non-valvular atrial fibrillation, especially in cases in which oral anticoagulant therapy is contraindicated. It is well established the usefulness of the left atrial appendage removal in patients with rheumatic mitral valve disease and atrial fibrillation. Theoretically, removal of the left atrial appendage in patients with mitral valve disease in normal sinus rhythm could have several advantages, taking into account that 26% of mitral valve operations exhibits postoperative atrial fibrillation. Nevertheless, further randomized studies are needed to answer if LAA should be removed in all cases of MV surgery. Should the Left Atrial Appendage Always be Removed in Mital ValveSurgery? In Search of a Perfect Outfit 2/2

show abstract

Ischaemic and haemorrhagic stroke associated with non-vitamin K antagonist oral anticoagulants and warfarin use in patients with atrial fibrillation: a nationwide cohort study

Abstract: Among anticoagulant-naïve AF patients, treatment with NOACs was not associated with significantly lower risk of stroke/TE compared with VKA, but intracranial bleeding risk was significantly lower with dabigatran and apixaban.

Cited by 70 publications

References 21 publications

Standard and reduced doses of dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation: a nationwide cohort study

Standard and reduced doses of dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation: a nationwide cohort study

Experience in the Use of Oral Anticoagulants in Outpatient Clinics

Should the Left Atrial Appendage Always be Removed in Mital Valve Surgery? In Search of a Perfect Outfit

Contact Info

Product

Resources

About