Next Article in Journal
Do Redox Balance and Inflammatory Events Take Place in Mild Bronchiectasis? A Hint to Clinical Implications
Next Article in Special Issue
Anticoagulation Prior to COVID-19 Infection Has No Impact on 6 Months Mortality: A Propensity Score–Matched Cohort Study
Previous Article in Journal
Microbiota and Its Impact on the Immune System in COVID-19—A Narrative Review
Previous Article in Special Issue
A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind?
 
 
Article

Effectiveness and Safety of Non-Vitamin K Oral Anticoagulants in Non-Valvular Atrial Fibrillation Patients: Results of A Real-World Study in a Metropolitan Area of Northern Italy

1
Epidemiology Unit, Agency for Health Protection (ATS) of Milan, C.so Italia, 19, 20122 Milan, Italy
2
Pharmacy Department, Agency for Health Protection (ATS) of Milan, C.so Italia, 19, 20122 Milan, Italy
3
General Directorate, Agency for Health Protection (ATS) of Milan, C.so Italia, 19, 20122 Milan, Italy
4
Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
*
Author to whom correspondence should be addressed.
Academic Editors: Giulio Francesco Romiti, Giovanni Di Salvo and Roberto De Ponti
J. Clin. Med. 2021, 10(19), 4536; https://doi.org/10.3390/jcm10194536
Received: 11 August 2021 / Revised: 23 September 2021 / Accepted: 26 September 2021 / Published: 30 September 2021
Background: New oral anticoagulant agents (NOACs) are valid alternatives for vitamin K antagonists (VKA) in patients with non-valvular atrial fibrillation (NVAF) for stroke prevention. In clinical practice, NOACs users may differ from patients enrolled in clinical trials in age or comorbidities, and thus it is a critical issue to evaluate the effectiveness and safety of NOACs in the real-world. Accordingly, we assessed two-year overall mortality and hospital admissions for myocardial infarction, stroke or bleeding in patients with NVAF users of NOACs compared to warfarin-treated patients. Methods: This is a population-based retrospective new user active comparator study. All atrial fibrillation patients who were naïve and not switcher users of oral anticoagulants from January 2017 to December 2019 were included (n = 8543). Data were obtained from the electronic health records of the Milan Agency for Health Protection, Italy. Two-year risks for overall mortality, myocardial infarction, stroke and bleeding were computed using Cox models. Age, sex, number of comorbidities, use of platelet aggregation inhibitors and Proton pump inhibitors and area of residence were used as confounding factors. We also controlled by indication bias-weighting NOACs and warfarin users based on the weights computed by a Kernel propensity score. Results: For all NOACs, we found a decrease in the risks compared with warfarin for mortality (from −25% to −49%), hospitalization for myocardial infarction (from −16% to −27%, statistically significant for apixaban, edoxaban and rivaroxaban) and ischemic stroke (from −23% to −41%, significant for dabigatran and apixaban). The risk of bleeding was decreased for rivaroxaban (−33%) and numerically but not significantly for the other NOACs. Conclusions: After two years of follow-up, in comparison with warfarin, NOACs users showed a significant reduction of overall mortality (all NOACs), hospital admission for myocardial infarction (apixaban and edoxaban), ischemic stroke (dabigatran) and bleeding (rivaroxaban). View Full-Text
Keywords: atrial fibrillation; new oral anticoagulant agents; effectiveness; safety; real-world atrial fibrillation; new oral anticoagulant agents; effectiveness; safety; real-world
MDPI and ACS Style

Crocetti, E.; Cattaneo, S.; Bergamaschi, W.; De Servi, S.; Russo, A.G. Effectiveness and Safety of Non-Vitamin K Oral Anticoagulants in Non-Valvular Atrial Fibrillation Patients: Results of A Real-World Study in a Metropolitan Area of Northern Italy. J. Clin. Med. 2021, 10, 4536. https://doi.org/10.3390/jcm10194536

AMA Style

Crocetti E, Cattaneo S, Bergamaschi W, De Servi S, Russo AG. Effectiveness and Safety of Non-Vitamin K Oral Anticoagulants in Non-Valvular Atrial Fibrillation Patients: Results of A Real-World Study in a Metropolitan Area of Northern Italy. Journal of Clinical Medicine. 2021; 10(19):4536. https://doi.org/10.3390/jcm10194536

Chicago/Turabian Style

Crocetti, Emanuele, Sarah Cattaneo, Walter Bergamaschi, Stefano De Servi, and Antonio Giampiero Russo. 2021. "Effectiveness and Safety of Non-Vitamin K Oral Anticoagulants in Non-Valvular Atrial Fibrillation Patients: Results of A Real-World Study in a Metropolitan Area of Northern Italy" Journal of Clinical Medicine 10, no. 19: 4536. https://doi.org/10.3390/jcm10194536

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop