Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Population
2.2. Use of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) in Stroke Prevention
2.3. Statistical Analysis
3. Results
3.1. Study Population
3.2. OAC Administration
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variables | Rivaroxaban (N = 1199) | Dabigatran (N = 819) | Apixaban (N = 953) | p |
---|---|---|---|---|
Dose reduction, N (%) | 412 (34.3) | 325 (39.7) | 334 (35) | <0.001 |
Indication for reduction * | ||||
Body weight ≤ 60 kg, N (%) | 78 (18.9) | 39 (12) | 58 (17.3) ** | <0.001 |
Age ≥ 80 years, N (%) | 191 (46.4) | 168 (51.7) | 215 (64.4) ** | <0.001 |
Creatinine > 1.5 mg/dL, N (%) | 98 (23.8) | 55 (16.9) | 123 (36.8) ** | <0.001 |
eGFR, 15–29 mL/min/1.73 m2, N (%) | 20 (4.9) | 6 (1.8) | 48 (14.4) | <0.001 |
eGFR, 15–49 mL/min/1.73 m2, N (%) | 194 (47.1) | 95 (29.2) | 80 (24) | <0.001 |
Dual antiplatelet therapy, N (%) | 102 (24.8) | 77 (23.7) | 172 (51.5) | <0.001 |
Incidents of gastrointestinal hemorrhage, N (%) | 11 (2.7) | 10 (3.1) | 24 (7.2) | <0.001 |
Incidents of cerebral hemorrhage, N (%) | 6 (1.5) | 4 (1.2) | 12 (3.6) | <0.001 |
Verapamil, N (%) | 1 (0.2) | 1 (0.3) | 4 (1.2) | <0.001 |
No indication for reduction, N (%) | 114 (27.7) | 95 (29.2) | 168 (50.3) | <0.001 |
Total, N = 3999 | Patients without Ischemic Stroke in the Past, N = 3520 | Patients with Ischemic Stroke in the Past, N = 479 | p | |
---|---|---|---|---|
Age, years | 72 (16) | 72 (16) | 74 (15) | 0.001 |
Female gender, N (%) | 1704 (42.6%) | 1481 (42%) | 223 (47%) | 0.06 |
Body mass index, kg/m2 | 28.4 (6.4) | 28.7 (6.5) | 27.7 (6.3) | 0.005 |
Paroxysmal atrial fibrillation, N (%) | 1923 (48.1%) | 1694 (48%) | 229 (48%) | 0.9 |
Persistent atrial fibrillation, N (%) | 933 (23.3%) | 855 (24%) | 78 (16%) | <0.001 |
Permanent atrial fibrillation, N (%) | 1143 (28.6%) | 971 (28%) | 172 (36%) | <0.001 |
Hypertension, N (%) | 3344 (83.6%) | 2927 (83%) | 417 (87%) | 0.030 |
Diabetes, N (%) | 1366 (34.2%) | 1176 (33%) | 190 (40%) | 0.007 |
Heart failure, N (%) | 2621 (65.5%) | 2275 (65%) | 346 (72%) | 0.001 |
EF (%) | 53% (20.0) | 54% (20.0) | 50% (21.3) | 0.057 |
Coronary artery disease, N (%) | 2011 (50.3%) | 1710 (49%) | 301 (63%) | <0.0001 |
Previous myocardial infarction, N (%) | 894 (22.4%) | 752 (21%) | 142 (30%) | <0.0001 |
Chronic kidney disease, N (%) | 1029 (25.7%) | 878 (25%) | 151 (32%) | 0.002 |
Peripheral artery disease, N (%) | 582 (14.6%) | 414 (12%) | 168 (35%) | <0.0001 |
Previous transient ischemic attack, N (%) | 190 (4.8%) | 150 (4%) | 40 (8%) | <0.0001 |
Previous peripheral embolism, N (%) | 46 (1.2%) | 35 (1%) | 11 (2%) | 0.012 |
Previous incidents of gastrointestinal hemorrhage, N (%) | 155 (3.9%) | 127 (4%) | 28 (6%) | 0.017 |
CHA2DS2-VASc score (points) | 4.0 (2) | 7.0 (2) | <0.0001 |
All N = 3999 | Patients without Previous Ischemic Stroke, N = 3520 | Patients with Previous Ischemic Stroke, N = 479 | p | |
---|---|---|---|---|
Acetylsalicylic acid, N (%) | 607 (15.3%) | 535 (15.2%) | 72 (15.0%) | 0.938 |
Clopidogrel, N (%) | 539 (13.6%) | 471 (13.4%) | 68 (14.2%) | 0.612 |
Ticagrelor, N (%) | 5 (0.1%) | 5 (0.1%) | 0 (0.0%) | 0.410 |
Diltiazem, N (%) | 5 (0.1%) | 4 (0.1%) | 1 (0.2%) | 0.580 |
Verapamil, N (%) | 22 (0.6%) | 19 (0.5%) | 3 (0.6%) | 0.809 |
Amiodarone, N (%) | 751 (19.0%) | 666 (18.9%) | 85 (17.7%) | 0.544 |
Beta blocker, N (%) | 3398 (86.0%) | 2982 (84.7%) | 416 (86.8%) | 0.184 |
Propafenone, N (%) | 383 (9.7%) | 345 (9.8%) | 38 (7.9%) | 0.195 |
Digoxin, N (%) | 317 (8.0%) | 283 (8.0%) | 34 (7.1%) | 0.478 |
Angiotensin I-converting enzyme inhibitor, N (%) | 2393 (60.5%) | 2103 (59.7%) | 290 (60.5%) | 0.713 |
Sartan, N (%) | 722 (18.3%) | 633(18.0%) | 89 (18.6%) | 0.741 |
Aldosterone receptor antagonist, N (%) | 1600 (40.5%) | 1394 (39.6%) | 206 (43.0%) | 0.146 |
Other diuretic, N (%) | 2566 (64.9%) | 2237 (63.6%) | 329 (68.7%) | 0.024 |
Dihydropyridine calcium antagonist, N (%) | 1264 (32.0%) | 1096 (31.1%) | 168 (35.1%) | 0.078 |
Statin, N (%) | 2928 (74.1%) | 2529 (71.8%) | 399 (83.3%) | <0.0001 |
All N = 3999 | Patients without Previous Ischemic Stroke, N = 3520 | Patients with Previous Ischemic Stroke, N = 479 | p | |
---|---|---|---|---|
Hemoglobin, g/dL | 13.3 (2.4) | 133 (2.3) | 13.1 (2.3) | 0.034 |
White blood cells, ×109/L | 7.49 (2.9) | 7.48 (2.9) | 7.54 (3.1) | 0.219 |
Platelet, ×109/L | 210 (83) | 209 (83) | 213 (84.5) | 0.937 |
Creatinine, mg/dL | 1.1 (0.47) | 1.1 (0.5) | 1.155 (0.5) | 0.013 |
eGFR, mL/min/1.73 m2 | 60 (22.2) | 60 (22) | 58 (20.8) | 0.004 |
Alanine aminotransferaze, U/L | 24 (16) | 24 (16) | 23 (13) | 0.108 |
Aspartate aminotransferase, U/L | 26 (13) | 26 (13) | 27 (15) | 0.853 |
INR | 1.3 (0.6) | 1.3 (0.6) | 1.4 (0.6) | 0.050 |
Uric acid, mg/dL | 6.7 (2.4) | 6.7 (2.3) | 6.89 (2.3) | 0.231 |
Hemoglobin A1c, % | 6.45 (1.5) | 6.43 (1.5) | 6.6 (1.8) | 0.159 |
Fasting glucose, mg/dL | 103 (29) | 103 (29) | 103 (33.9) | 0.756 |
Thyroid-stimulating hormone, uIU/mL | 1.6 (1.8) | 1.6 (1.8) | 1.62 (1.7) | 0.590 |
Total cholesterol, mg/dL | 152 (70.3) | 152 (71.3) | 150.81 (63) | 0.466 |
Low-density lipoprotein cholesterol, mg/dL | 84 (64) | 85 (64.7) | 81.6 (60.5) | 0.548 |
High-density lipoprotein cholesterol, mg/dL | 45 (18) | 45 (18) | 45.62 (19.9) | 0.396 |
Triglycerides, mg/dL | 109 (70) | 109.41 (69.5) | 106 (72) | 0.788 |
Nr. of Patients with Previous Ischemic Stroke (N = 479) (%) | Nr. of Patients without Previous Ischemic Stroke (N = 3520) (%) | p-Value for Differences between Groups | Implications for Dose Reduction in Patients with Previous Ischemic Stroke (%) | Implications for Dose Reduction in Patients without Previous Ischemic Stroke (%) | p-Value for Differences between Groups | Dose Reduction in Patients with Previous Ischemic Stroke (%) | Dose Reduction in Patients without Previous Ischemic Stroke (%) | p-Value for Differences between Groups | |
---|---|---|---|---|---|---|---|---|---|
Oral anticoagulation therapy | 439 (92%) | 3172 (90%) | 0.52 | N/A | N/A | N/A | N/A | N/A | N/A |
VKA | 83 (18.9%) | 557 (17.6%) | 0.45 | N/A | N/A | N/A | N/A | N/A | N/A |
Rivaroxaban | 135 (30.8%) | 1064 (33.5%) | 0.24 | 64 (47.4%) | 394 (37.0%) | 0.02 | 66 (48.9%) | 346 (32.5%) | <0.001 |
Dabigatran | 112 (25.5%) | 707 (22.3%) | 0.13 | 40 (35.7%) | 231 (32.7%) | 0.53 | 51 (45.5%) | 274 (38.8%) | 0.17 |
Apixaban | 109 (24.8%) | 844 (26.6%) | 0.43 | 31 (28.4%) | 259 (30.7%) | 0.63 | 40 (36.7%) | 294 (34.8%) | 0.7 |
p-value for differences between NOACs | 0.09 | <0.001 | 0.007 | 0.01 | 0.17 | 0.03 |
Reduction without Conditions in Patients with Previous Ischemic Stroke (%) | Reduction without Conditions in Patients without Previous Ischemic Stroke (%) | p-Value | Reduction with Conditions in Patients with Previous Ischemic Stroke (%) | Reduction with Conditions in Patients without Previous Ischemic Stroke (%) | p-Value | No Reduction with Conditions in Patients with Previous Ischemic Stroke (%) | No Reduction with Conditions without Previous Ischemic Stroke (%) | p-Value | |
---|---|---|---|---|---|---|---|---|---|
Rivaroxaban | 19 (28.8%) | 95 (27.5%) | 0.06 | 47 (71.2%) | 251 (72.5%) | 0.004 | 17 (12.6%) | 143 (13.4%) | 0.79 |
Dabigatran | 29 (56.9%) | 122 (44.5%) | 0.03 | 22 (43.1%) | 152 (55.5%) | 0.66 | 18 (16.1%) | 79 (11.2%) | 0.14 |
Apixaban | 24 (60.0%) | 144 (49.0%) | 0.20 | 16 (40.0%) | 151 (51.4%) | 0.18 | 15 (13.8%) | 109 (12.9%) | 0.81 |
p-value for differences between NOACs | 0.06 | <0.001 | 0.008 | <0.001 | 0.782 | 0.359 |
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Szyszkowska, A.; Kuźma, Ł.; Wożakowska-Kapłon, B.; Gorczyca-Głowacka, I.; Jelonek, O.; Uziębło-Życzkowska, B.; Krzesiński, P.; Wójcik, M.; Błaszczyk, R.; Gawałko, M.; et al. Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry. Int. J. Environ. Res. Public Health 2022, 19, 11939. https://doi.org/10.3390/ijerph191911939
Szyszkowska A, Kuźma Ł, Wożakowska-Kapłon B, Gorczyca-Głowacka I, Jelonek O, Uziębło-Życzkowska B, Krzesiński P, Wójcik M, Błaszczyk R, Gawałko M, et al. Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry. International Journal of Environmental Research and Public Health. 2022; 19(19):11939. https://doi.org/10.3390/ijerph191911939
Chicago/Turabian StyleSzyszkowska, Anna, Łukasz Kuźma, Beata Wożakowska-Kapłon, Iwona Gorczyca-Głowacka, Olga Jelonek, Beata Uziębło-Życzkowska, Paweł Krzesiński, Maciej Wójcik, Robert Błaszczyk, Monika Gawałko, and et al. 2022. "Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry" International Journal of Environmental Research and Public Health 19, no. 19: 11939. https://doi.org/10.3390/ijerph191911939
APA StyleSzyszkowska, A., Kuźma, Ł., Wożakowska-Kapłon, B., Gorczyca-Głowacka, I., Jelonek, O., Uziębło-Życzkowska, B., Krzesiński, P., Wójcik, M., Błaszczyk, R., Gawałko, M., Kapłon-Cieślicka, A., Tokarek, T., Rajtar-Salwa, R., Bil, J., Wojewódzki, M., Szpotowicz, A., Krzciuk, M., Bednarski, J., Bakuła, E., ... Tomaszuk-Kazberuk, A. (2022). Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry. International Journal of Environmental Research and Public Health, 19(19), 11939. https://doi.org/10.3390/ijerph191911939