Afib: anticoagulants and risk for all-cause mortality

  • Gieling E & al.
  • Int J Clin Pharm
  • 8 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with atrial fibrillation (Afib), the use of non-vitamin K oral anticoagulants (NOACs) or aspirin was associated with an increased risk for all-cause mortality compared with vitamin K antagonists (VKAs) use.
  • The risk was higher in patients with a CHA2DS2-VASc score >2 (medium to high stroke risk) and was more pronounced in men.

Why this matters

  • The increased risk for all-cause mortality reflects clinical practice where high-risk patients receive NOACs over VKA or aspirin.

Study design

  • Cohort study included 31,497 patients with Afib newly prescribed NOACs (n=1306), VKAs (n=16,094) and low-dose aspirin (n=454) using data from the UK Clinical Practice Research Datalink (CPRD).
  • Main outcome: all-cause mortality.
  • Funding: None.

Key results

  • NOACs (adjusted HR [aHR], 1.42; 95% CI, 1.18-1.71) and aspirin (aHR, 1.64; 95% CI, 1.57-1.77) users were significantly at an increased risk for all-cause mortality vs VKA users.
  • The risk for all-cause mortality was significantly higher in women with NOACs use vs those with VKAs use (aHR, 1.67; 95% CI, 1.51-1.86).
  • Among men, the risk for all-cause mortality was significantly higher in NOACs (aHR, 1.72; 95% CI, 1.25-2.36) and aspirin (aHR, 1.63; 95% CI, 1.46-1.82) users vs VKAs users.
  • Among patients with high CHA2DS2-VASc score (≥4), NOACs (aHR, 1.38; 95% CI, 1.06-1.80) and aspirin (aHR, 1.74; 95% CI, 1.57-1.94) users were significantly at a higher risk for all-cause mortality vs VKAs users.

Limitations

  • Potential risk for residual and unmeasured confounding.