TY - JOUR
T1 - Dose reduction of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation
T2 - A Danish nationwide cohort study
AU - Xing, Lucas Yixi
AU - Barcella, Carlo Alberto
AU - Sindet-Pedersen, Caroline
AU - Bonde, Anders Nissen
AU - Gislason, Gunnar Hilmar
AU - Olesen, Jonas Bjerring
PY - 2019/6
Y1 - 2019/6
N2 - Introduction: To investigate the patterns of dose reduction of non-vitamin K antagonist oral anticoagulants (NOAC) in patients with atrial fibrillation (AF). Materials and methods: Using Danish nationwide registries, we identified all non-valvular AF patients initiated on standard-dose NOAC during 2011–2017 who were followed until dose reduction. The absolute risk of dose reduction was presented as cumulative incidence both overall and according to baseline characteristics. Moreover, to assess baseline comorbidities related to dose reduction, adjusted Cox regression models were used. In subgroup analysis, we investigated dose reduction following acute myocardial infarction and/or percutaneous coronary intervention (MI/PCI), chronic kidney disease (CKD), turned 80 years, intracranial hemorrhage, peripheral bleeding, ischemic stroke, cancer, bone fracture, and antiplatelet treatment start. Results: Of 24,489 patients included, 12.2% experienced dose reduction during the study period. Dabigatran treatment, higher age at inclusion, high CHA 2 DS 2 -VASc score, and high HAS-BLED score were related to higher risk of dose reduction. Baseline ischemic heart disease (IHD), heart failure, cancer, CKD, chronic obstructive pulmonale disease (COPD), and hypertension were independent predictors of dose reduction. In subgroup analysis with six-month follow-up, MI/PCI, CKD, intracranial hemorrhage, peripheral bleeding, and antiplatelet treatment therapy were strongly associated with dose reduction. Conclusions: Dose reduction of NOACs was observed in 12.2% of AF patients during 2011–2017 and was associated with dabigatran treatment, advanced age at baseline, high CHA 2 DS 2 -VASc score, and high HAS-BLED score. Among comorbidities, IHD, heart failure, cancer, CKD, COPD, and hypertension predicted dose reduction independently. During six-month follow-up, MI/PCI showed the strongest association with dose reduction.
AB - Introduction: To investigate the patterns of dose reduction of non-vitamin K antagonist oral anticoagulants (NOAC) in patients with atrial fibrillation (AF). Materials and methods: Using Danish nationwide registries, we identified all non-valvular AF patients initiated on standard-dose NOAC during 2011–2017 who were followed until dose reduction. The absolute risk of dose reduction was presented as cumulative incidence both overall and according to baseline characteristics. Moreover, to assess baseline comorbidities related to dose reduction, adjusted Cox regression models were used. In subgroup analysis, we investigated dose reduction following acute myocardial infarction and/or percutaneous coronary intervention (MI/PCI), chronic kidney disease (CKD), turned 80 years, intracranial hemorrhage, peripheral bleeding, ischemic stroke, cancer, bone fracture, and antiplatelet treatment start. Results: Of 24,489 patients included, 12.2% experienced dose reduction during the study period. Dabigatran treatment, higher age at inclusion, high CHA 2 DS 2 -VASc score, and high HAS-BLED score were related to higher risk of dose reduction. Baseline ischemic heart disease (IHD), heart failure, cancer, CKD, chronic obstructive pulmonale disease (COPD), and hypertension were independent predictors of dose reduction. In subgroup analysis with six-month follow-up, MI/PCI, CKD, intracranial hemorrhage, peripheral bleeding, and antiplatelet treatment therapy were strongly associated with dose reduction. Conclusions: Dose reduction of NOACs was observed in 12.2% of AF patients during 2011–2017 and was associated with dabigatran treatment, advanced age at baseline, high CHA 2 DS 2 -VASc score, and high HAS-BLED score. Among comorbidities, IHD, heart failure, cancer, CKD, COPD, and hypertension predicted dose reduction independently. During six-month follow-up, MI/PCI showed the strongest association with dose reduction.
KW - Apixaban
KW - Atrial fibrillation
KW - Dabigatran
KW - Dose reduction
KW - NOAC
KW - Rivaroxaban
U2 - 10.1016/j.thromres.2019.04.007
DO - 10.1016/j.thromres.2019.04.007
M3 - Journal article
C2 - 31004965
AN - SCOPUS:85064265766
VL - 178
SP - 101
EP - 109
JO - Thrombosis Research
JF - Thrombosis Research
SN - 0049-3848
ER -