BACKGROUND: Over the past 5 years, dabigatran, rivaroxaban and apixaban were approved for stroke prevention. Phase III studies have shown a lower risk of intracranial bleeding with these direct oral anticoagulants than with warfarin; however, there is a lack of real-life data to validate this. We analyzed time trends in atraumatic intracranial bleeding from 2009 to 2013 among patients prescribed oral anticoagulants and those not prescribed oral anticoagulants. METHODS: We used ICD-10-CA (enhanced Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems) codes to identify all patients with atraumatic intracranial bleeding who presented to our neurosurgical centre (serving a population of more than 1.2 million). Trained researchers extracted data on anticoagulant medications used in the week before diagnosis of the intracranial bleed. Provincial prescription data for oral anticoagulants were obtained from IMS Brogan CompuScript Market Dynamics. The primary outcome was the time trend in incident intracranial bleeds associated with oral anticoagulation during the period 2009-2013. The secondary outcomes were the time trend in intracranial bleeds not associated with oral anticoagulation and the provincial prescribing patterns for oral anticoagulants during the same period. RESULTS: A total of 2050 patients presented with atraumatic intracranial bleeds during the study period. Of the 371 (18%) prescribed an anticoagulant in the week before presentation, 335 were prescribed an oral anticoagulant. There was an increasing time trend in intracranial bleeding associated with oral anticoagulants (p = 0.009; 6 additional events per year) and in intracranial bleeding not associated with oral anticoagulation (p = 0.06). During 2013, prescriptions for warfarin decreased to 70% of all oral anticoagulant prescriptions in the province, whereas those for dabigatran and rivaroxaban increased to 17% and 12%, respectively. INTERPRETATION: We observed increasing time trends in intracranial bleeding, both associated with and not associated with oral anticoagulants, over the study period. Although aggregate provincial data showed increased prescribing of oral anticoagulants, other more likely explanations for our findings include an aging population or increasing frailty.
BACKGROUND: Over the past 5 years, dabigatran, rivaroxaban and apixaban were approved for stroke prevention. Phase III studies have shown a lower risk of intracranial bleeding with these direct oral anticoagulants than with warfarin; however, there is a lack of real-life data to validate this. We analyzed time trends in atraumatic intracranial bleeding from 2009 to 2013 among patients prescribed oral anticoagulants and those not prescribed oral anticoagulants. METHODS: We used ICD-10-CA (enhanced Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems) codes to identify all patients with atraumatic intracranial bleeding who presented to our neurosurgical centre (serving a population of more than 1.2 million). Trained researchers extracted data on anticoagulant medications used in the week before diagnosis of the intracranial bleed. Provincial prescription data for oral anticoagulants were obtained from IMS Brogan CompuScript Market Dynamics. The primary outcome was the time trend in incident intracranial bleeds associated with oral anticoagulation during the period 2009-2013. The secondary outcomes were the time trend in intracranial bleeds not associated with oral anticoagulation and the provincial prescribing patterns for oral anticoagulants during the same period. RESULTS: A total of 2050 patients presented with atraumatic intracranial bleeds during the study period. Of the 371 (18%) prescribed an anticoagulant in the week before presentation, 335 were prescribed an oral anticoagulant. There was an increasing time trend in intracranial bleeding associated with oral anticoagulants (p = 0.009; 6 additional events per year) and in intracranial bleeding not associated with oral anticoagulation (p = 0.06). During 2013, prescriptions for warfarin decreased to 70% of all oral anticoagulant prescriptions in the province, whereas those for dabigatran and rivaroxaban increased to 17% and 12%, respectively. INTERPRETATION: We observed increasing time trends in intracranial bleeding, both associated with and not associated with oral anticoagulants, over the study period. Although aggregate provincial data showed increased prescribing of oral anticoagulants, other more likely explanations for our findings include an aging population or increasing frailty.
Authors: Jan Beyer-Westendorf; Kati Förster; Sven Pannach; Franziska Ebertz; Vera Gelbricht; Christoph Thieme; Franziska Michalski; Christina Köhler; Sebastian Werth; Kurtulus Sahin; Luise Tittl; Ulrike Hänsel; Norbert Weiss Journal: Blood Date: 2014-05-23 Impact factor: 22.113
Authors: Anne-Sophie Larock; François Mullier; Anne-Laure Sennesael; Jonathan Douxfils; Bérangère Devalet; Christian Chatelain; Jean-Michel Dogné; Anne Spinewine Journal: Ann Pharmacother Date: 2014-06-30 Impact factor: 3.154
Authors: François Laliberté; Michel Cloutier; Winnie W Nelson; Craig I Coleman; Dominic Pilon; William H Olson; C V Damaraju; Jeffrey R Schein; Patrick Lefebvre Journal: Curr Med Res Opin Date: 2014-04-02 Impact factor: 2.580
Authors: Elaine M Hylek; Claes Held; John H Alexander; Renato D Lopes; Raffaele De Caterina; Daniel M Wojdyla; Kurt Huber; Petr Jansky; Philippe Gabriel Steg; Michael Hanna; Laine Thomas; Lars Wallentin; Christopher B Granger Journal: J Am Coll Cardiol Date: 2014-03-19 Impact factor: 24.094
Authors: Graeme J Hankey; Susanna R Stevens; Jonathan P Piccini; Yuliya Lokhnygina; Kenneth W Mahaffey; Jonathan L Halperin; Manesh R Patel; Günter Breithardt; Daniel E Singer; Richard C Becker; Scott D Berkowitz; John F Paolini; Christopher C Nessel; Werner Hacke; Keith A A Fox; Robert M Califf Journal: Stroke Date: 2014-04-17 Impact factor: 7.914
Authors: Ammar Majeed; Hun-Gyu Hwang; Stuart J Connolly; John W Eikelboom; Michael D Ezekowitz; Lars Wallentin; Martina Brueckmann; Mandy Fraessdorf; Salim Yusuf; Sam Schulman Journal: Circulation Date: 2013-09-30 Impact factor: 29.690