Trends over time in oral anticoagulation and stroke rates in atrial fibrillation: A community-based study

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-11 DOI:10.1016/j.jstrokecerebrovasdis.2024.108081

Brent A. Williams PhD , James C. Blankenship MD , Stephen Voyce MD , Alexander R. Chang MD

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引用次数: 0

Abstract

Objectives

Over the last decade, direct oral anticoagulants (DOAC) have become preferred over warfarin for stroke prevention in atrial fibrillation (AF). The objectives of this study were to quantify the shift over time from warfarin to DOACs and parallel changes in ischemic and hemorrhagic stroke rates in AF.

Materials and methods

This community-based retrospective study was undertaken within a single integrated health care network from 2011 to 2021. Changes over time in warfarin and DOAC use were quantified by year, both overall and stratified by CHA₂DS₂-VASc score. Ischemic and hemorrhagic stroke rate changes over time were evaluated by Poisson regression. Stroke rates were evaluated in different time eras: 2011–2015 and 2016–2021.

Results

Among 31,978 AF patients followed an average of 5.5 years, any OAC use increased from 50.2 % (2011) to 59.4 % (2020) (p < 0.001). Warfarin use decreased from 49.3 % to 30.8 %, while DOAC use increased from 2.0 % to 30.8 % (both p < 0.001). In 2020, patients with CHA₂DS₂-VASc 0–1 and 2–5 were more likely to use DOACs than warfarin (18.6 % vs. 6.7 %; 33.0 % vs. 28.2 %), whereas in CHA₂DS₂-VASc 6–9 DOACs were used less frequently (30.0 % vs. 40.8 %). Ischemic stroke rates significantly increased by 19 % (95 % CI: 7 %, 32 %) from 2011 to 2015, but significantly decreased by 18 % (10 %, 26 %) from 2016 to 2021. Hemorrhagic stroke rates stabilized in 2016–2021 (+3 %; −18 %, 30 %) after increasing in 2011–2015 (+36 %; 4 %, 78 %).

Conclusion

Improvements in ischemic and hemorrhagic stroke rates coincided temporally with increased uptake of OACs and a shift toward increased uptake of DOACs relative to warfarin.

查看原文本刊更多论文

心房颤动患者口服抗凝药和中风发生率的长期趋势：一项基于社区的研究。

目的：在过去十年中，直接口服抗凝剂 (DOAC) 已成为心房颤动 (AF) 预防卒中的首选药物，而不是华法林。本研究的目的是量化从华法林到 DOAC 的转变过程以及心房颤动患者缺血性和出血性卒中发生率的平行变化：这项基于社区的回顾性研究于 2011 年至 2021 年在一个单一的综合医疗保健网络内进行。华法林和 DOAC 的使用随时间的变化按年份进行量化，既包括总体变化，也包括按 CHA2DS2-VASc 评分进行分层的变化。缺血性和出血性卒中率随时间的变化通过泊松回归进行评估。中风发生率在不同时间段进行评估：2011-2015 年和 2016-2021 年：在平均随访 5.5 年的 31978 名房颤患者中，使用任何 OAC 的比例从 50.2%（2011 年）增加到 59.4%（2020 年）（P2DS2-VASc 0-1 和 2-5 更有可能使用 DOAC，而不是华法林（18.6% 对 6.7%；33.0% 对 28.2%），而 CHA2DS2-VASc 6-9 DOAC 的使用频率较低（30.0% 对 40.8%））。缺血性脑卒中发病率在 2011-2015 年间显著增加了 19%（95% CI：7%，32%），但在 2016-2021 年间显著下降了 18%（10%，26%）。出血性中风发病率在2011-2015年上升（+36%；4%，78%）后，2016-2021年趋于稳定（+3%；-18%，30%）：缺血性和出血性卒中发生率的改善与 OACs 摄入量的增加以及 DOACs 摄入量相对于华法林的增加在时间上相吻合。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.