Kefale Adane Teshome, Bezabhe Woldesellassie M, Peterson Gregory M
School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia.
J Clin Med. 2023 Sep 25;12(19):6182. doi: 10.3390/jcm12196182.
The use of oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and low stroke risk might cause more harm than benefit. Little attention has been given to address its prevalence and associated consequences. This study aimed to investigate the prescription rate of OACs, identify associated factors, and describe incident bleeding events in low-risk patients.
We included patients with a new diagnosis of AF between 1 January 2011 and 31 December 2018 having a low risk of stroke (CHADS-VASc score of 0 for males and 1 for females) from Australian general practice data (MedicineInsight). Patients were classified as OAC users if there was a recorded prescription of an OAC within 60 days of AF diagnosis, and factors associated with the prescription of an OAC were assessed using logistic regression. Recorded incident bleeding events were identified within 6 months after AF diagnosis or after OAC initiation for OAC non-users and users, respectively. The risk of bleeding was compared between the two groups by adjusting their baseline differences using propensity score matching.
The study included 2810 low-risk patients (62.3% male) with a mean age of 49.3 ± 10.8 years. Of the total, 705 (25.1%) patients had a record of OAC prescription within 60 days of diagnosis of AF. Older age (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.03-1.04) and diagnosis periods (2015-2016 [OR 1.46; 95% CI 1.10-1.94] and 2017-2018 [OR 1.65; 95% CI 1.17-2.23] vs. 2011-2012) were associated with higher odds of OAC initiation. Female sex (OR 0.71; 95% CI 0.59-0.85), higher bleeding risk (ORBIT score; OR 0.80; 95% CI 0.68-0.94), and higher socioeconomic index for areas (SEIFA) quintiles (SEIFA quintiles; 2 [OR 0.65; 95% CI 0.48-0.88], 3 [OR 0.74; 95% CI 0.56-0.98], 4 [OR 0.70; 95% CI 0.52-0.94], 5 [OR 0.69; 95% CI 0.52-0.91] compared with quintile 1) were associated with lower odds of OAC prescription. A total of 52 (in 1.8% of patients) incident bleeds were identified, with 18 (2.6%) among OAC users. The rate of bleeding was not significantly different between users and non-users after matching. However, within OAC users, commencement of OAC was associated with an increased risk of bleeding compared to the period before OAC initiation ( = 0.006).
One in four patients at low risk of stroke received an OAC within 60 days of AF diagnosis. Older age and the period following the widespread availability of direct-acting OACs were associated with an increased likelihood of OAC prescription. Positively, using OACs was not associated with an increased rate of bleeding compared to non-users.
在心房颤动（AF）且中风风险较低的患者中使用口服抗凝剂（OAC）可能弊大于利。目前对其流行情况及相关后果关注较少。本研究旨在调查OAC的处方率，确定相关因素，并描述低风险患者的出血事件。
我们纳入了2011年1月1日至2018年12月31日期间新诊断为AF且中风风险较低（男性CHADS-VASc评分为0，女性为1）的患者，数据来自澳大利亚全科医疗数据（MedicineInsight）。如果在AF诊断后60天内有OAC的处方记录，则将患者分类为OAC使用者，并使用逻辑回归评估与OAC处方相关的因素。分别在AF诊断后6个月内或OAC非使用者和使用者开始使用OAC后识别记录的出血事件。通过倾向得分匹配调整两组的基线差异，比较两组的出血风险。
该研究纳入了2810名低风险患者（男性占62.3%），平均年龄为49.3±10.8岁。其中，705名（25.1%）患者在AF诊断后60天内有OAC处方记录。年龄较大（比值比[OR]1.03；95%置信区间[CI]1.03 - 1.04）和诊断时期（2015 - 2016年[OR 1.46；95% CI 1.10 - 1.94]和2017 - 2018年[OR 1.65；95% CI 1.17 - 2.23]与2011 - 2012年相比）与开始使用OAC的较高几率相关。女性（OR 0.71；95% CI 0.59 - 0.85）、较高的出血风险（ORBIT评分；OR 0.80；95% CI 0.68 - 0.94）以及较高的地区社会经济指数（SEIFA）五分位数（SEIFA五分位数；与第1五分位数相比，2[OR 0.65；95% CI 0.48 - 0.88]、3[OR 0.74；95% CI 0.56 - 0.98]、4[OR 0.70；95% CI 0.52 - 0.94]、5[OR 0.69；95% CI 0.52 - 0.91]）与OAC处方的较低几率相关。共识别出52例（占患者的1.8%）出血事件，其中OAC使用者中有18例（2.6%）。匹配后使用者和非使用者之间的出血率无显著差异。然而，在OAC使用者中，与开始使用OAC之前的时期相比，开始使用OAC与出血风险增加相关（P = 0.006）。
四分之一的中风低风险患者在AF诊断后60天内接受了OAC治疗。年龄较大以及直接作用OAC广泛可用后的时期与OAC处方可能性增加相关。积极的一面是，与非使用者相比，使用OAC与出血率增加无关。
