Impact of Direct Oral Anticoagulant Uptake on Hospitalizations for Stroke/Transient Ischemic Attack, Intracranial Hemorrhage, and Gastrointestinal Bleeding in Individuals With Atrial Fibrillation: A Population-Based Study

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Fundamental & Clinical Pharmacology Pub Date : 2025-10-07 DOI:10.1111/fcp.70051

Tony Antoniou, Daniel McCormack, Tianru Wang, Mina Tadrous, Tara Gomes

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引用次数: 0

Abstract

Background

Direct-acting oral anticoagulants (DOACs) have largely replaced warfarin for stroke prevention in patients with atrial fibrillation, yet their population-level impact on health outcomes and costs remains unclear. We examined whether the widespread uptake of DOACs was associated with changes in hospitalization rates and costs for stroke/transient ischemic attack (TIA), intracranial hemorrhage (ICH), and gastrointestinal bleeding among individuals with atrial fibrillation receiving publicly funded anticoagulation.

Methods

We conducted a population-based ecological time series study using administrative health data from Ontario, Canada, between 2003 and 2021. We used segmented negative binomial regression and generalized additive models to estimate immediate and post-DOAC uptake trends in hospitalization rates and costs following increased use of DOACs in 2012.

Results

We identified 12,134 hospitalizations for ICH, 59 946 for gastrointestinal bleeding, and 40 724 for stroke/TIA among anticoagulated individuals with atrial fibrillation. Following DOAC uptake, ICH rates (rate ratio [RR]: 0.88; 95% CI: 0.86–0.90) and costs (RR: 0.74; 95% CI: 0.62–0.88) declined immediately, with continued quarterly declines. Gastrointestinal bleeding rates increased initially (RR: 1.17; 95% CI: 1.14–1.20) and declined over time (RR per quarter: 0.99; 95% CI: 0.99–0.99). Gastrointestinal bleeding-related costs did not change significantly. Stroke/TIA rates remained stable, but hospitalization costs declined ($366 per 1000 individuals per quarter; 95% CI: −$562 to −$170).

Conclusion

DOAC uptake was associated with reduced ICH rates and costs and an initial increase but subsequent decline in gastrointestinal bleeding rates. Despite stable stroke rates, reduced costs suggest potential long-term economic benefits. Our findings support the real-world effectiveness and safety of DOACs.

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查看原文本刊更多论文

直接口服抗凝剂对房颤患者中风/短暂性脑缺血发作、颅内出血和胃肠道出血住院的影响：一项基于人群的研究

背景：直接作用口服抗凝剂（DOACs）已在很大程度上取代华法林用于房颤患者的卒中预防，但其在人群水平上对健康结局和成本的影响尚不清楚。我们研究了在接受公共资助抗凝治疗的房颤患者中，DOACs的广泛应用是否与卒中/短暂性脑缺血发作（TIA）、颅内出血（ICH）和胃肠道出血的住院率和费用的变化有关。方法：我们利用加拿大安大略省2003年至2021年间的行政卫生数据进行了一项基于人口的生态时间序列研究。我们使用分段负二项回归和广义相加模型来估计2012年doac使用增加后住院率和费用的即时和后吸收趋势。结果：在抗凝房颤患者中，我们确定了12,134例脑出血住院，59946例胃肠道出血住院，40724例卒中/TIA住院。采用DOAC后，ICH率（比率比[RR]: 0.88; 95% CI: 0.86-0.90）和成本（RR: 0.74; 95% CI: 0.62-0.88）立即下降，并持续季度下降。胃肠道出血率最初增加（RR: 1.17; 95% CI: 1.14-1.20），并随着时间的推移下降（每季度RR: 0.99; 95% CI: 0.99-0.99）。胃肠道出血相关费用没有显著变化。卒中/TIA发生率保持稳定，但住院费用下降（每季度每1000人366美元；95% CI: - 562美元至- 170美元）。结论：DOAC摄取与脑出血率和成本降低以及胃肠道出血率的初始增加和随后下降有关。尽管中风率稳定，但降低的成本表明潜在的长期经济效益。我们的研究结果支持doac在现实世界中的有效性和安全性。

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

Fundamental & Clinical Pharmacology 医学-药学

CiteScore

5.30

自引率

6.90%

发文量

111

审稿时长

6-12 weeks

期刊介绍： Fundamental & Clinical Pharmacology publishes reports describing important and novel developments in fundamental as well as clinical research relevant to drug therapy. Original articles, short communications and reviews are published on all aspects of experimental and clinical pharmacology including: Antimicrobial, Antiviral Agents Autonomic Pharmacology Cardiovascular Pharmacology Cellular Pharmacology Clinical Trials Endocrinopharmacology Gene Therapy Inflammation, Immunopharmacology Lipids, Atherosclerosis Liver and G-I Tract Pharmacology Metabolism, Pharmacokinetics Neuropharmacology Neuropsychopharmacology Oncopharmacology Pediatric Pharmacology Development Pharmacoeconomics Pharmacoepidemiology Pharmacogenetics, Pharmacogenomics Pharmacovigilance Pulmonary Pharmacology Receptors, Signal Transduction Renal Pharmacology Thrombosis and Hemostasis Toxicopharmacology Clinical research, including clinical studies and clinical trials, may cover disciplines such as pharmacokinetics, pharmacodynamics, pharmacovigilance, pharmacoepidemiology, pharmacogenomics and pharmacoeconomics. Basic research articles from fields such as physiology and molecular biology which contribute to an understanding of drug therapy are also welcomed.