Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry
Background: The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). Methods: The Polish AF (POL-AF) registry is a prospective, observational, multicen...
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Published in | International journal of environmental research and public health Vol. 19; no. 19; p. 11939 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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21.09.2022
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ISSN | 1660-4601 1661-7827 1660-4601 |
DOI | 10.3390/ijerph191911939 |
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Abstract | Background: The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). Methods: The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. Results: Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA2DS2-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use—out of reduced dosage groups, p = 0.06). Conclusions: A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction. |
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AbstractList | The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants).BACKGROUNDThe aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants).The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past.METHODSThe Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past.Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA2DS2-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use-out of reduced dosage groups, p = 0.06).RESULTSAmong 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA2DS2-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use-out of reduced dosage groups, p = 0.06).A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction.CONCLUSIONSA significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction. The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA DS -VASc score (median score 7 vs. 4, < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use-out of reduced dosage groups, = 0.06). A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction. Background: The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). Methods: The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. Results: Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA2DS2-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use—out of reduced dosage groups, p = 0.06). Conclusions: A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction. Background: The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). Methods: The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. Results: Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA 2 DS 2 -VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use—out of reduced dosage groups, p = 0.06). Conclusions: A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction. |
Author | Jelonek, Olga Tomaszuk-Kazberuk, Anna Błaszczyk, Robert Szpotowicz, Anna Bednarski, Janusz Bakuła, Elwira Mamcarz, Artur Kuźma, Łukasz Wożakowska-Kapłon, Beata Uziębło-Życzkowska, Beata Krzesiński, Paweł Rajtar-Salwa, Renata Bil, Jacek Krzciuk, Małgorzata Wełnicki, Marcin Wójcik, Maciej Szyszkowska, Anna Tokarek, Tomasz Gawałko, Monika Gorczyca-Głowacka, Iwona Wojewódzki, Michał Kapłon-Cieślicka, Agnieszka |
AuthorAffiliation | 6 Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland 2 Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland 12 Department of Invasive Cardiology, Center of Postgraduate Medical Education, 02-776 Warsaw, Poland 14 Department of Cardiology, St. John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland 4 Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland 3 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland 1 Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland 7 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland 10 Center for Invasive Cardiology, Electrotherapy and Angiology, 38-400 Nowy Sacz, Poland 13 Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swietokrzyski, Poland 9 Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, 45147 Essen, |
AuthorAffiliation_xml | – name: 3 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland – name: 8 Department of Cardiology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, 6229 ER Maastricht, The Netherlands – name: 9 Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, 45147 Essen, Germany – name: 12 Department of Invasive Cardiology, Center of Postgraduate Medical Education, 02-776 Warsaw, Poland – name: 1 Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland – name: 15 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland – name: 5 Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland – name: 13 Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swietokrzyski, Poland – name: 2 Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland – name: 7 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland – name: 14 Department of Cardiology, St. John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland – name: 6 Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland – name: 10 Center for Invasive Cardiology, Electrotherapy and Angiology, 38-400 Nowy Sacz, Poland – name: 4 Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland – name: 11 Cardiology and Cardiovascular Interventions Clinical Department, The University Hospital, 30-688 Krakow, Poland |
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Keywords | atrial fibrillation reduced dose ischemic stroke anticoagulation |
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Snippet | Background: The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced... The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs... |
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SubjectTerms | Administration, Oral Anticoagulants Atrial Fibrillation - chemically induced Atrial Fibrillation - drug therapy Atrial Fibrillation - epidemiology Cardiac arrhythmia Cardiovascular disease Dabigatran - adverse effects Dabigatran - therapeutic use Embolisms Fibrinolytic Agents - therapeutic use Heart attacks Humans Ischemic Stroke Kidney diseases Mortality Patients Poland - epidemiology Population Prospective Studies Pyridones Registries Rivaroxaban - adverse effects Stroke Vein & artery diseases |
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Title | Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry |
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