Atrial Fibrillation
Conditions
Brief summary
Oral anticoagulant (OAC) treatment with either vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) is essential in patients with atrial fibrillation for the prevention of stroke or systemic embolism (SE) a condition that happens when a blood clot forms elsewhere in the body and travels through the blood stream to plug another vessel. While there are significant number of real-world publications on the use and outcomes of NOACs for stroke prevention, evidence from routine clinical practice on the use and outcomes of reduced doses of NOACs is scarce. By evaluating routine clinical practice data from national registers in Denmark, Finland, Norway and Sweden, researchers want to gather information about the safety and how well reduced doses of NOACs work in patients with irregularly heartbeats which are not caused by a heart valve problem (non-valvular atrial fibrillation, NVAF). As a primary aim of this study, treatment with low doses of NOACs (Xarelto \[generic name rivaroxaban\], Eliquis \[generic name apixaban\] or Pradaxa \[generic name dabigatran\]) will be compared with VKAs (warfarin) in Nordic patients with NVAF to assess the occurrence of stroke and systemic embolism \[effectiveness\]) and intracranial hemorrhage a type of bleeding that occurs inside the skull \[safety\]).
Interventions
DRUGWarfarin
VKA
NOAC, reduced dose
DRUGApixaban
NOAC, reduced dose
DRUGDabigatran
NOAC, reduced dose
Sponsors
Johnson & Johnson
Bayer
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with a qualifying oral OAC dispensed during the study period * A primary diagnosis indicative of atrial fibrillation during the baseline period
Exclusion criteria
* Age \< 18 years at index date * Died on index date * A diagnosis of valvular disease, pregnancy, transient cause of atrial fibrillation or venous thromboembolism in the baseline period or on the index date * Hip or knee replacement surgery in the 60 days prior to or on the index date * A dispensed prescription of heparin or fondaparinux in the 60 days prior to or on the index date * A diagnosis of end-stage kidney disease or renal replacement therapy in the baseline period or on the index date * More than one dispensed OAC (any dose of rivaroxaban, apixaban, dabigatran, edoxaban, or warfarin) on the index date * A dispensed prescription of an OAC (any dose of rivaroxaban, apixaban, dabigatran, edoxaban, or warfarin) during the baseline period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants with ischemic stroke (IS) or systemic embolism (SE) | Retrospective analysis from 2010 - 2018 | Evaluation will be done in participants treated with reduced doses of individual NOACs and with VKA |
| Number of participants with intracranial haemorrhage (ICH) | Retrospective analysis from 2010 - 2018 | Evaluation will be done in participants treated with reduced doses of individual NOACs and with VKA |
Countries
Sweden
Outcome results
None listed