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Trends in warfarin use and its associations with thromboembolic and bleeding rates in a population with atrial fibrillation between 1996 and 2011
PLOS ONE ( IF 3.7 ) Pub Date : 2018-03-16 , DOI: 10.1371/journal.pone.0194295
Peter Wæde Hansen , Thomas S. G. Sehested , Emil Loldrup Fosbøl , Christian Torp-Pedersen , Lars Køber , Charlotte Andersson , Gunnar H. Gislason

Aim

Warfarin is a cornerstone for the prevention of thromboembolism in atrial fibrillation (AF), and several efforts have been taken to increase its usage and safety, including risk stratification schemes. Our aim was to investigate the temporal trends in initiation of warfarin and its effects on incidence of bleeding and thromboembolism in patients with new-onset atrial fibrillation 1996–2011.

Methods

All patients with a first-time diagnosis of non-valvular atrial fibrillation were identified from nationwide administrative registries. Trends were determined by linear regression.

Results

In total 153,682 patients were included. Initiation of warfarin increased from 14% to 41% (p<0.0001). Events of thromboembolism decreased from 3.9% to 2.6% annually (p<0.0001). The greatest decline in thromboembolic events was observed for patients with a CHA2DS2VASc score >1, where the annual decline was -0.12% (95%CI: -0.161; -0.084)) for those treated with warfarin and -0.073% (95%CI: -0.116;-0.030)) for those not treated with warfarin. Bleeding increased from 3.3% to 3.9% (p = 0.043). For those with a CHA2DS2VASc score >1 annual bleeding rates increased by 0.095% (95%CI: -0.025; -0.165) in warfarin treated and by 0.056% (95%CI: -0.013; -0.100) in patients not treated with warfarin.

Conclusion

Warfarin use increased by nearly a 3-fold between 1996 and 2011. During the same period, thromboembolic events declined by a third and bleeding increased by a fifth, suggesting a beneficial effect associated with higher warfarin use. Notably, a small decline in thromboembolic events and increase in bleeding events was observed for the untreated population, suggesting a changing risk profile of AF patients.



中文翻译:

1996年至2011年间房颤患者使用华法林的趋势及其与血栓栓塞和出血率的关系

目的

华法林是预防心房颤动(AF)中血栓栓塞的基石,并已采取了一些努力来增加其使用和安全性,包括风险分层方案。我们的目的是调查1996-2011年新发房颤患者华法林起始的时间趋势及其对出血和血栓栓塞发生率的影响。

方法

从全国性行政登记处确定了所有首次诊断为非瓣膜性心房颤动的患者。趋势通过线性回归确定。

结果

总共153,682名患者被纳入研究。华法林起始剂量从14%增加到41%(p <0.0001)。血栓栓塞事件从每年的3.9%下降到2.6%(p <0.0001)。对于CHA 2 DS 2 VASc得分> 1的患者,血栓栓塞事件的下降最大,其中华法林治疗的患者和-0.073%的患者的年度下降为-0.12%(95%CI:-0.161; -0.084)。 (95%CI:-0.116; -0.030))。出血从3.3%增加到3.9%(p = 0.043)。对于CHA 2 DS 2 VASc评分> 1的患者,华法林治疗的年出血率增加0.095%(95%CI:-0.025; -0.165),患者的年出血率增加0.056%(95%CI:-0.013; -0.100)不用华法林治疗。

结论

在1996年至2011年期间,华法林的使用增加了近3倍。在同一时期,血栓栓塞事件减少了三分之一,出血增加了五分之一,这表明与使用华法林有关的有益作用。值得注意的是,未治疗人群的血栓栓塞事件略有下降,而出血事件则有所增加,提示房颤患者的风险状况正在发生变化。

更新日期:2018-03-17
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