BACKGROUND: Nonvalvular atrial fibrillation is associated with a substantial risk of stroke. Novel oral anticoagulants (NOACs) with predictable anticoagulant effect and no need for routine coagulation monitoring have recently shown good results when compared with warfarin in phase III clinical trials. OBJECTIVE: To describe clinical features and pharmacological treatments of a population-based cohort of patients with nonvalvular atrial fibrillation and ascertain whether they are comparable with those included in the three main phase III clinical trials on NOACs. RESULTS: Of the 2,862,264 subjects considered for this study 13,360 patients (0.47%) were recently discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation. Mean age was 76.3 (SD 10.7), 49.8% were men and 64.6% were ≥75 years of age. 50% of patients were treated with warfarin and 44.1% with antiplatelet agents. The proportion of patients on antiplatelet therapy increased with age up to a rate of 54.3% in subjects ≥85 years. 92.9% of the studied cohort was on polypharmacy (mean 8 drugs/patient). Around 20% of the entire cohort was treated with amiodarone, a drug potentially interfering with NOACs, and 3.6% from a subgroup analysis had renal failure, which is an exclusion criterion in trials on NOACs. CONCLUSION: In patients recently discharged from the hospital with the diagnosis of nonvalvular AF, warfarin use decreases and aspirin treatment increases with patients' age. These patients are older, more frequently female, and on multiple medications. The benefit of NOACs in these subjects needs to be confirmed in phase IV clinical studies.
BACKGROUND:Nonvalvular atrial fibrillation is associated with a substantial risk of stroke. Novel oral anticoagulants (NOACs) with predictable anticoagulant effect and no need for routine coagulation monitoring have recently shown good results when compared with warfarin in phase III clinical trials. OBJECTIVE: To describe clinical features and pharmacological treatments of a population-based cohort of patients with nonvalvular atrial fibrillation and ascertain whether they are comparable with those included in the three main phase III clinical trials on NOACs. RESULTS: Of the 2,862,264 subjects considered for this study 13,360 patients (0.47%) were recently discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation. Mean age was 76.3 (SD 10.7), 49.8% were men and 64.6% were ≥75 years of age. 50% of patients were treated with warfarin and 44.1% with antiplatelet agents. The proportion of patients on antiplatelet therapy increased with age up to a rate of 54.3% in subjects ≥85 years. 92.9% of the studied cohort was on polypharmacy (mean 8 drugs/patient). Around 20% of the entire cohort was treated with amiodarone, a drug potentially interfering with NOACs, and 3.6% from a subgroup analysis had renal failure, which is an exclusion criterion in trials on NOACs. CONCLUSION: In patients recently discharged from the hospital with the diagnosis of nonvalvular AF, warfarin use decreases and aspirin treatment increases with patients' age. These patients are older, more frequently female, and on multiple medications. The benefit of NOACs in these subjects needs to be confirmed in phase IV clinical studies.
Authors: Brian Godman; Rickard E Malmström; Eduardo Diogene; Sisira Jayathissa; Stuart McTaggart; Thomas Cars; Samantha Alvarez-Madrazo; Christoph Baumgärtel; Anna Brzezinska; Anna Bucsics; Stephen Campbell; Irene Eriksson; Alexander Finlayson; Jurij Fürst; Kristina Garuoliene; Iñaki Gutiérrez-Ibarluzea; Krystyna Hviding; Harald Herholz; Roberta Joppi; Marija Kalaba; Ott Laius; Kamila Malinowska; Hanne B Pedersen; Vanda Markovic-Pekovic; Jutta Piessnegger; Gisbert Selke; Catherine Sermet; Susan Spillane; Dominik Tomek; Luka Vončina; Vera Vlahović-Palčevski; Janet Wale; Magdalena Wladysiuk; Menno van Woerkom; Corinne Zara; Lars L Gustafsson Journal: Front Pharmacol Date: 2014-06-10 Impact factor: 5.810
Authors: Michael Ermisch; Anna Bucsics; Patricia Vella Bonanno; Francis Arickx; Alexander Bybau; Tomasz Bochenek; Marc van de Casteele; Eduardo Diogene; Jurij Fürst; Kristina Garuolienė; Martin van der Graaff; Jolanta Gulbinovič; Alan Haycox; Jan Jones; Roberta Joppi; Ott Laius; Irene Langner; Antony P Martin; Vanda Markovic-Pekovic; Laura McCullagh; Einar Magnusson; Ellen Nilsen; Gisbert Selke; Catherine Sermet; Steven Simoens; Robert Sauermann; Ad Schuurman; Ricardo Ramos; Vera Vlahovic-Palcevski; Corinne Zara; Brian Godman Journal: Front Pharmacol Date: 2016-09-28 Impact factor: 5.810
Authors: Rickard E Malmström; Brian B Godman; Eduard Diogene; Christoph Baumgärtel; Marion Bennie; Iain Bishop; Anna Brzezinska; Anna Bucsics; Stephen Campbell; Alessandra Ferrario; Alexander E Finlayson; Jurij Fürst; Kristina Garuoliene; Miguel Gomes; Iñaki Gutiérrez-Ibarluzea; Alan Haycox; Krystyna Hviding; Harald Herholz; Mikael Hoffmann; Saira Jan; Jan Jones; Roberta Joppi; Marija Kalaba; Christina Kvalheim; Ott Laius; Irene Langner; Julie Lonsdale; Sven-Äke Lööv; Kamila Malinowska; Laura McCullagh; Ken Paterson; Vanda Markovic-Pekovic; Andrew Martin; Jutta Piessnegger; Gisbert Selke; Catherine Sermet; Steven Simoens; Cankat Tulunay; Dominik Tomek; Luka Vončina; Vera Vlahovic-Palcevski; Janet Wale; Michael Wilcock; Magdalena Wladysiuk; Menno van Woerkom; Corrine Zara; Lars L Gustafsson Journal: Front Pharmacol Date: 2013-05-14 Impact factor: 5.810
Authors: Abdulla Shehab; Asim A Elnour; Adel Sadik; Mahmoud Abu Mandil; Ali AlShamsi; Aesha Al Suwaidi; AkshayaSrikanth Bhagavathula; Pinar Erkekoglu; Farah Hamad; Saif K Al Nuaimi Journal: Saudi Med J Date: 2015-11 Impact factor: 1.484