Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
Br J Clin Pharmacol. 2022 Aug;88(8):3847-3855. doi: 10.1111/bcp.15337. Epub 2022 Apr 8.
Schizophrenia is associated with poor anticoagulation control and clinical prognosis in patients with atrial fibrillation (AF). Little is known about initiation of oral anticoagulation therapy (OAC) in this patient population.
In the nationwide Danish health registries, we identified all patients with incident AF and schizophrenia with indication for OAC treatment. Patients with schizophrenia (n = 673) were matched 1:5 on sex, age, stroke risk score, and calendar-period to incident AF patients without schizophrenia. We calculated absolute risk and risk difference (RD) of OAC initiation, adjusting for stroke and bleeding risk factors. Analyses were stratified by calendar period (2000-2011 and 2012-2018) to account for changes after the introduction of non-vitamin K OACs (NOAC).
Among patients with schizophrenia (mean age 69.5 years, 50.3% females), 33.7% initiated OAC within the first year after AF diagnosis, compared with 54.4% of patients without schizophrenia, corresponding to an adjusted RD of -20.7 (95% confidence interval [CI]: -24.7 to -16.7). OAC initiation increased over time regardless of schizophrenia status. During 2000-2011, 18.3% of patients with schizophrenia and 42.9% without schizophrenia initiated OAC (adjusted RD -23.6%, 95% CI -28.8 to -18.6). During 2012-2018, this was 48.5% and 65.7%, respectively (adjusted RD -14.4%, 95% CI -20.4 to -8.4).
Initiation of OAC was substantially lower among patients with AF and schizophrenia compared with matched AF peers. These findings accentuate the importance of close attention to disparities in initiation of OAC treatment, and potential missed opportunities for prevention of disabling strokes in AF patients with schizophrenia.
在患有心房颤动（AF）的患者中，精神分裂症与抗凝控制不良和临床预后不良相关。对于这一患者群体开始口服抗凝治疗（OAC）的情况，知之甚少。
在全国性的丹麦健康登记处，我们确定了所有有 OAC 治疗指征的新发 AF 和精神分裂症患者。将 673 名精神分裂症患者按性别、年龄、中风风险评分和时间进行 1:5 配对，与无精神分裂症的新发 AF 患者进行匹配。我们计算了 OAC 起始的绝对风险和风险差异（RD），并根据中风和出血风险因素进行了调整。分析按时间（2000-2011 年和 2012-2018 年）分层，以考虑到非维生素 K 口服抗凝剂（NOAC）引入后的变化。
在精神分裂症患者中（平均年龄 69.5 岁，50.3%为女性），33.7%在 AF 诊断后 1 年内开始 OAC，而无精神分裂症的患者中这一比例为 54.4%，相应的调整 RD 为-20.7（95%置信区间[CI]：-24.7 至-16.7）。无论精神分裂症状态如何，OAC 的起始率都随时间增加。在 2000-2011 年期间，18.3%的精神分裂症患者和 42.9%的非精神分裂症患者开始 OAC（调整后的 RD-23.6%，95%CI-28.8 至-18.6）。在 2012-2018 年期间，这一比例分别为 48.5%和 65.7%（调整后的 RD-14.4%，95%CI-20.4 至-8.4）。
与匹配的 AF 患者相比，AF 和精神分裂症患者开始 OAC 的比例明显较低。这些发现强调了密切关注 OAC 治疗起始方面的差异以及在精神分裂症 AF 患者中预防致残性中风的潜在机会缺失的重要性。
