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Grundtvig J, Ovesen C, Havsteen I, Christensen T, Gaist D, Iversen HK, Kruuse C, Lilja-Cyron A, Ægidius K, Rosenbaum S, Meden P, Marstrand J, Christensen L, Steiner T, Christensen H. Trends in incidence of oral anticoagulant-related intracerebral hemorrhage and sales of oral anticoagulants in Capital Region of Denmark 2010-2017. Eur Stroke J 2021; 6:143-150. [PMID: 34414289 DOI: 10.1177/23969873211008770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/16/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Non-vitamin K-antagonist oral anticoagulants (NOAC) have become first choice oral anticoagulant (OAC) with decreasing use of vitamin K antagonists (VKA), partly due to lower risk of intracerebral hemorrhage (ICH). Aim: to identify trends in sale of OACs and relate them to trends in OAC-related ICH (OAC-ICH). Patients and methods Study was based on the population in the Capital Region of Denmark (1.8 million inhabitants). We identified all patients admitted with a non-traumatic OAC-ICH in 2010-2017 and ascertained diagnosis and drug use through medical charts. We used information available in the public domain on sale of defined daily doses (DDD) of OAC in the Capital Region of Denmark. Results 453 patients with OAC-ICH out of a total of 2877 ICH-events were identified. From 2010 to 2017 sale of NOAC rose from 0.1 to 11.8 DDD/1000 inhabitants/day (p < 0.001); while VKA sale decreased from 7.6 to 5.2 DDD/1000 inhabitants/day (p < 0.001). The total number of ICH events was stable between 2010 and 2017, but the proportion of OAC-ICH events increased from 13% in 2010 to 22% in 2017 (p < 0.001). The proportion of ICH events related to NOAC had a significant increasing trend (p < 0.001), whereas a decreasing trend was observed for VKA (p = 0.04). Discussion In Denmark, the population on OACs has increased; resulting from increased use of NOACs. Parallel to this development, the proportion of OAC-ICH overall has increased based on an increasing trend in NOAC-related ICH. Conclusion Our findings document a need for further research on prevention and treatment of this complication.
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Affiliation(s)
| | - Christian Ovesen
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | - David Gaist
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, Neurology Research Unit, University of Southern Denmark, Odense, Denmark
| | - Helle K Iversen
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Karen Ægidius
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Per Meden
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jacob Marstrand
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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Rubboli A, Agewall S, Huber K, Lip GYH. New-onset atrial fibrillation after recent coronary stenting: Warfarin or non-vitamin K-antagonist oral anticoagulants to be added to aspirin and clopidogrel? A viewpoint. Int J Cardiol 2015; 196:133-8. [PMID: 26093527 DOI: 10.1016/j.ijcard.2015.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/12/2015] [Indexed: 01/10/2023]
Abstract
The antithrombotic management of patients on oral anticoagulation (OAC), with either warfarin or non-vitamin K-antagonist oral anticoagulants (NOACs), undergoing percutaneous coronary intervention with stent (PCI-S) has been recently addressed in a joint European consensus document. In accordance, triple therapy (TT) of OAC, aspirin and clopidogrel should generally be given as the initial therapy. More uncertainty exists over whether warfarin or a NOAC should be added in patients already on dual antiplatelet therapy of aspirin and clopidogrel (DAPT) after recent PCI-S. Upon review of available data, it appears that the risk of major bleeding of TT as compared to DAPT is similar with either warfarin or a NOAC. In particular, TT consistently appears associated to an approximately 2.5 fold increase in the risk of major bleeding. Because of the higher convenience, NOACs might be considered the preferred OAC to be added to DAPT. Given the reported different safety profiles of the various NOACs on the incidence of major, and gastrointestinal, bleeding, the NOACs, and the dose, showing the greatest safety in this regard should be selected. In accordance, dabigatran 110 mg and apixaban 2.5mg twice daily appear as the most valuable options in patients who are not and who are respectively, at increased risk of bleeding. As an alternative, apixaban 5mg twice daily might be considered in patients at risk of bleeding not increased, whereas rivaroxaban 15 mg once daily may be considered in the presence of increased risk of bleeding (essentially when related to moderate renal impairment).
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Affiliation(s)
- Andrea Rubboli
- Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy.
| | - Stefan Agewall
- Institute of Clinical Sciences, Department of Cardiology, University of Oslo, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Gregory Y H Lip
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
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