Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients

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Abstract

Objective: Oral anticoagulation (OAC) prescribed to AF patients for the prevention of cardioembolic complications likely has the added benefit of preventing venous thromboembolism (VTE). This study evaluated, among AF patients who are anticoagulated, whether type of OAC was associated with subsequent VTE risk. Methods: Non-valvular AF patients prescribed OACs between 2010 and September 2015 were identified via the MarketScan administrative claims databases. OACs included warfarin and direct OACs (DOACs: dabigatran, rivaroxaban, and apixaban). Incident VTE was defined by ICD-9-CM codes. Patients were matched on age, sex, CHA 2 DS 2 -VASc, and high-dimensional propensity scores. The final analysis included 117,912 AF patients. Results: In total, 1357 VTE events accrued over a mean follow-up of 484 days. In multivariable-adjusted, propensity score-matched Cox models, relative to new users of warfarin, risk of incident VTE was lower among new users of dabigatran [hazard ratio (95% confidence interval) = 0.55 (0.47–0.66)] and apixaban [0.51 (0.39–0.68)], but similar among new users of rivaroxaban [1.01 (0.87–1.19)]. In head-to-head DOAC comparisons, VTE risk was lower among users of dabigatran [0.48 (0.36–0.64)] and apixaban [0.61 (0.47–0.78)] vs rivaroxaban. Findings were mostly similar across patient sub-groups. Conclusions: In this large practice-based population of AF patients prescribed OACs for primary prevention of stroke and systemic embolization, subsequent risk of VTE was lowest among those prescribed apixaban and dabigatran, while risk was similar with prescriptions for warfarin and rivaroxaban. Among AF patients prescribed OACs, lowering the risk of VTE may be an additional benefit of apixaban and dabigatran, beyond the reduced bleeding risk observed in randomized clinical trials.

Original languageEnglish (US)
Pages (from-to)837-845
Number of pages9
JournalCurrent Medical Research and Opinion
Volume35
Issue number5
DOIs
StatePublished - May 4 2019

Fingerprint

Venous Thromboembolism
Atrial Fibrillation
Warfarin
Propensity Score
Therapeutics
International Classification of Diseases
Primary Prevention
Proportional Hazards Models
Prescriptions
Randomized Controlled Trials
Stroke
Dabigatran
apixaban
Databases
Confidence Intervals
Hemorrhage
Rivaroxaban
Population

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Comparative effectiveness
  • Venous thromboembolism

PubMed: MeSH publication types

  • Journal Article

Cite this

@article{4da9080c2c4445499db6cab4ea8b8b65,
title = "Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients",
abstract = "Objective: Oral anticoagulation (OAC) prescribed to AF patients for the prevention of cardioembolic complications likely has the added benefit of preventing venous thromboembolism (VTE). This study evaluated, among AF patients who are anticoagulated, whether type of OAC was associated with subsequent VTE risk. Methods: Non-valvular AF patients prescribed OACs between 2010 and September 2015 were identified via the MarketScan administrative claims databases. OACs included warfarin and direct OACs (DOACs: dabigatran, rivaroxaban, and apixaban). Incident VTE was defined by ICD-9-CM codes. Patients were matched on age, sex, CHA 2 DS 2 -VASc, and high-dimensional propensity scores. The final analysis included 117,912 AF patients. Results: In total, 1357 VTE events accrued over a mean follow-up of 484 days. In multivariable-adjusted, propensity score-matched Cox models, relative to new users of warfarin, risk of incident VTE was lower among new users of dabigatran [hazard ratio (95{\%} confidence interval) = 0.55 (0.47–0.66)] and apixaban [0.51 (0.39–0.68)], but similar among new users of rivaroxaban [1.01 (0.87–1.19)]. In head-to-head DOAC comparisons, VTE risk was lower among users of dabigatran [0.48 (0.36–0.64)] and apixaban [0.61 (0.47–0.78)] vs rivaroxaban. Findings were mostly similar across patient sub-groups. Conclusions: In this large practice-based population of AF patients prescribed OACs for primary prevention of stroke and systemic embolization, subsequent risk of VTE was lowest among those prescribed apixaban and dabigatran, while risk was similar with prescriptions for warfarin and rivaroxaban. Among AF patients prescribed OACs, lowering the risk of VTE may be an additional benefit of apixaban and dabigatran, beyond the reduced bleeding risk observed in randomized clinical trials.",
keywords = "Anticoagulation, Atrial fibrillation, Comparative effectiveness, Venous thromboembolism",
author = "Lutsey, {Pamela L} and Faye Norby and Zakai, {Neil A.} and Maclehose, {Richard F} and Chen, {Lin Yee} and Surbhi Shah and Datta, {Yvonne H} and Alvaro Alonso",
year = "2019",
month = "5",
day = "4",
doi = "10.1080/03007995.2018.1541445",
language = "English (US)",
volume = "35",
pages = "837--845",
journal = "Current Medical Research and Opinion",
issn = "0300-7995",
publisher = "Informa Healthcare",
number = "5",

}

TY - JOUR

T1 - Oral anticoagulation therapy and subsequent risk of venous thromboembolism in atrial fibrillation patients

AU - Lutsey, Pamela L

AU - Norby, Faye

AU - Zakai, Neil A.

AU - Maclehose, Richard F

AU - Chen, Lin Yee

AU - Shah, Surbhi

AU - Datta, Yvonne H

AU - Alonso, Alvaro

PY - 2019/5/4

Y1 - 2019/5/4

N2 - Objective: Oral anticoagulation (OAC) prescribed to AF patients for the prevention of cardioembolic complications likely has the added benefit of preventing venous thromboembolism (VTE). This study evaluated, among AF patients who are anticoagulated, whether type of OAC was associated with subsequent VTE risk. Methods: Non-valvular AF patients prescribed OACs between 2010 and September 2015 were identified via the MarketScan administrative claims databases. OACs included warfarin and direct OACs (DOACs: dabigatran, rivaroxaban, and apixaban). Incident VTE was defined by ICD-9-CM codes. Patients were matched on age, sex, CHA 2 DS 2 -VASc, and high-dimensional propensity scores. The final analysis included 117,912 AF patients. Results: In total, 1357 VTE events accrued over a mean follow-up of 484 days. In multivariable-adjusted, propensity score-matched Cox models, relative to new users of warfarin, risk of incident VTE was lower among new users of dabigatran [hazard ratio (95% confidence interval) = 0.55 (0.47–0.66)] and apixaban [0.51 (0.39–0.68)], but similar among new users of rivaroxaban [1.01 (0.87–1.19)]. In head-to-head DOAC comparisons, VTE risk was lower among users of dabigatran [0.48 (0.36–0.64)] and apixaban [0.61 (0.47–0.78)] vs rivaroxaban. Findings were mostly similar across patient sub-groups. Conclusions: In this large practice-based population of AF patients prescribed OACs for primary prevention of stroke and systemic embolization, subsequent risk of VTE was lowest among those prescribed apixaban and dabigatran, while risk was similar with prescriptions for warfarin and rivaroxaban. Among AF patients prescribed OACs, lowering the risk of VTE may be an additional benefit of apixaban and dabigatran, beyond the reduced bleeding risk observed in randomized clinical trials.

AB - Objective: Oral anticoagulation (OAC) prescribed to AF patients for the prevention of cardioembolic complications likely has the added benefit of preventing venous thromboembolism (VTE). This study evaluated, among AF patients who are anticoagulated, whether type of OAC was associated with subsequent VTE risk. Methods: Non-valvular AF patients prescribed OACs between 2010 and September 2015 were identified via the MarketScan administrative claims databases. OACs included warfarin and direct OACs (DOACs: dabigatran, rivaroxaban, and apixaban). Incident VTE was defined by ICD-9-CM codes. Patients were matched on age, sex, CHA 2 DS 2 -VASc, and high-dimensional propensity scores. The final analysis included 117,912 AF patients. Results: In total, 1357 VTE events accrued over a mean follow-up of 484 days. In multivariable-adjusted, propensity score-matched Cox models, relative to new users of warfarin, risk of incident VTE was lower among new users of dabigatran [hazard ratio (95% confidence interval) = 0.55 (0.47–0.66)] and apixaban [0.51 (0.39–0.68)], but similar among new users of rivaroxaban [1.01 (0.87–1.19)]. In head-to-head DOAC comparisons, VTE risk was lower among users of dabigatran [0.48 (0.36–0.64)] and apixaban [0.61 (0.47–0.78)] vs rivaroxaban. Findings were mostly similar across patient sub-groups. Conclusions: In this large practice-based population of AF patients prescribed OACs for primary prevention of stroke and systemic embolization, subsequent risk of VTE was lowest among those prescribed apixaban and dabigatran, while risk was similar with prescriptions for warfarin and rivaroxaban. Among AF patients prescribed OACs, lowering the risk of VTE may be an additional benefit of apixaban and dabigatran, beyond the reduced bleeding risk observed in randomized clinical trials.

KW - Anticoagulation

KW - Atrial fibrillation

KW - Comparative effectiveness

KW - Venous thromboembolism

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U2 - 10.1080/03007995.2018.1541445

DO - 10.1080/03007995.2018.1541445

M3 - Article

VL - 35

SP - 837

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JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 0300-7995

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ER -