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Risk factors for stroke and choice of oral anticoagulant in atrial fibrillation

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Abstract

Purpose

To investigate risk factors for stroke in patients initiating oral anticoagulants for atrial fibrillation in Norway and their association with receiving DOACs versus warfarin.

Methods

From nationwide registries, we identified naïve users initiating treatment with warfarin, dabigatran, rivaroxaban, or apixaban for atrial fibrillation from 2010 to 2015 in Norway. We studied temporal changes in the CHA2DS2-VASc score and its component risk factors. We used multiple logistic regressions to identify CHA2DS2-VASc risk factors associated with receiving DOACs versus warfarin in 2015.

Results

From 2010 to 2015, the yearly number of new oral anticoagulant users increased from 7588 to 13,344. All new users initiated warfarin in 2010, while 86% initiated a DOAC in 2015. The mean CHA2DS2-VASc score decreased from 3.2 (SD 1.7) to 3.1 (SD 1.6) in the same period. Vascular disease (0.56 [0.49–0.63]), congestive heart failure (OR 0.65 [95% CI 0.58–0.72]), and diabetes (0.83 [0.73–0.95]) decreased the odds of receiving DOACs instead of warfarin, and ischemic stroke/transient ischemic attack/arterial thromboembolism (1.31 [1.12–1.54]), age 65–74 (1.23 [1.06–1.43]), and female sex (1.22 [1.10–1.36]) increased it. Age ≥ 75 (reference age < 65) and hypertension had no impact.

Conclusions

The uptake of DOACs was rapid and spurred an increase in new users of oral anticoagulants for atrial fibrillation from 2010 to 2015 in Norway. The mean CHA2DS2-VASc score did not change substantially during this period. Vascular disease, heart failure, and diabetes were associated with initiation of warfarin, and previous stroke, age 65–74 and female sex with initiation of DOACs.

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Authors and Affiliations

  1. Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway

    Lars J. Kjerpeseth & Eva Skovlund

  2. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway

    Hanne Ellekjær

  3. Stroke Unit, Department of Internal Medicine, St. Olav’s Hospital, Trondheim, Norway

    Hanne Ellekjær

  4. Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway

    Randi Selmer, Inger Ariansen, Kari Furu & Eva Skovlund

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  1. Lars J. Kjerpeseth
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  2. Hanne Ellekjær
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Contributions

LJK did the analysis and wrote the manuscript. All authors helped plan and design the study, interpret findings, revise the manuscript, and approved the final version of the manuscript.

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Correspondence to Lars J. Kjerpeseth.

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The authors declare that they have no conflict of interest.

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Data from the Norwegian Patient Register has been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian Patient Register is intended nor should be inferred.

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Kjerpeseth, L.J., Ellekjær, H., Selmer, R. et al. Risk factors for stroke and choice of oral anticoagulant in atrial fibrillation. Eur J Clin Pharmacol 74, 1653–1662 (2018). https://doi.org/10.1007/s00228-018-2540-3

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