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Author Halvorsen, S.; Ghanima, W.; Fride Tvete, I.; Hoxmark, C.; Falck, P.; Solli, O.; Jonasson, C. url  doi
  Title A nationwide registry study to compare bleeding rates in patients with atrial fibrillation being prescribed oral anticoagulants Type Journal Article
  Year 2017 Publication European Heart Journal. Cardiovascular Pharmacotherapy Abbreviated Journal Eur Heart J Cardiovasc Pharmacother  
  Volume 3 Issue 1 Pages 28-36  
  Keywords Apixaban; Atrial fibrillation; Bleeding; Dabigatran; Non-vitamin K antagonist oral anticoagulants; Oral anticoagulants; Rivaroxaban; Warfarin  
  Abstract AIMS: We aimed to evaluate bleeding risk in clinical practice in patients with atrial fibrillation (AF) being prescribed dabigatran, rivaroxaban, or apixaban compared with warfarin. METHODS: Using nationwide registries (Norwegian Patient Registry and Norwegian Prescription Database), we identified AF patients with a first prescription of oral anticoagulants between January 2013 and June 2015. Patients were followed until discontinuation or switching of oral anticoagulants, death, or end of follow-up. The primary endpoint was major or clinically relevant non-major (CRNM) bleeding. RESULTS: In total 32 675 AF patients were identified (58% men, median age 74 years): 11 427 patients used warfarin, 7925 dabigatran, 6817 rivaroxaban, and 6506 apixaban. After a median follow-up of 173 days (25th, 75th percentile 84, 340), 2081 (6.37%) patients experienced a first major or CRNM bleeding. Using a Cox proportional hazard model adjusting for baseline characteristics, use of apixaban [hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.61-0.80, P < 0.001] and dabigatran (HR 0.74, 95% CI 0.66-0.84, P < 0.001) were associated with a lower risk of major or CRNM bleeding compared with warfarin whereas use of rivaroxaban was not (HR: 1.05, 95% CI 0.94-1.17, P = 0.400). Use of dabigatran and rivaroxaban were associated with higher risk of gastrointestinal bleeding, whereas use of apixaban and dabigatran were associated with lower risk of intracranial bleeding, compared with warfarin. CONCLUSION: In this nationwide cohort study in AF patients, apixaban and dabigatran were associated with a lower risk of major or CRNM bleeding compared with warfarin. The risk of gastrointestinal bleeding was higher with rivaroxaban and dabigatran compared with warfarin.  
  Address HUNT Research Center, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 2055-6845 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:27680880; PMCID:PMC5216196 Approved no  
  Call Number HUNT @ maria.stuifbergen @ Serial 1920  
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