Of the patients with atrial fibrillation who start oral anticoagulation, two-thirds have polypharmacy. Maxim Grymonprez (Ghent University) and colleagues calculated this on the basis of Belgian registration data. These patients have a higher risk of CVAs, systemic embolisms, death and major bleeding than people without polypharmacy. Direct-acting oral anticoagulants (DOACs) also have a more favorable profile for this group than vitamin K antagonists (Thromb Haemost. 2023; online 27 juni).
The researchers used claim data from people with Belgian health insurance, recorded by the InterMutualistic Agency. They selected all over-45s who started taking a DOAC or vitamin K antagonist (VKA) in the period 2013-2018 in a dose that is appropriate for non-valvular atrial fibrillation. After coupling with hospital data, they excluded patients who had recently had a hip or knee arthroplasty or a venous thromboembolism.
During the study period, 254,478 patients had started oral anticoagulation for atrial fibrillation. Two thirds of them had polypharmacy (concomitant use of ≥ 5 different drugs) and 21% had hyperpolypharmacy (≥ 10 drugs). Patients with polypharmacy were on average older (age: 76.3 vs. 72.5 years) and had more comorbidities.
During the median follow-up of 1.3 years, all effect measures (CVAs, systemic embolisms, and death) and all adverse events (major, intracranial, and gastrointestinal bleeding) occurred more frequently in patients with polypharmacy than in patients without polypharmacy, even after adjustment for age, gender and known comorbidities.
In patients with polypharmacy, DOACs were more beneficial than VKAs. Systemic embolisms and strokes were less common in DOAC users (adjusted haza ratio (aHR): 0.68; 95% CI: 0.63-0.73), as was mortality (aHR: 0.80, 0.77- 0.84). DOAC users also had less bleeding, although GI bleeding was more common in this group (aHR: 1.10; 95% CI: 1.01-1.19), with an unadjusted difference of 2.82 vs. 2.62 GI bleeding per 100 patient years.
The researchers advise better monitoring of patients with polypharmacy and to critically assess in a medication review whether medication that increases the risk of bleeding can be stopped.
2023-09-06 04:00:00
#DOAC #vitamin #antagonist #polypharmacy
