Risks and Benefits of Anticoagulation in Atrial Fibrillation: Insights From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry.
Circ Cardiovasc Qual Outcomes. 2013 Jun 11;
Authors: Cullen MW, Kim S, Piccini JP, Ansell JE, Fonarow GC, Hylek EM, Singer DE, Mahaffey KW, Kowey PR, Thomas L, Go AS, Lopes RD, Chang P, Peterson ED, Gersh BJ, on behalf of the ORBIT-AF Investigators
BACKGROUND: ), and anticoagulation and risk factors in AF (ATRIA) scores, respectively. The mean subject age was 73 years; 58% were men. Overall, 76% of patients received OAC (71% warfarin and 5% dabigatran). The use of OAC increased among those with higher CHADS2 scores, from 53% for CHADS2=0 to 80% for CHADS2≥2 (P<0.001). OAC use fell slightly with increasing ATRIA bleeding risk score, from 81% for ATRIA=3 to 73% for ATRIA≥5 (P<0.001). A significant interaction existed between ATRIA and CHADS2 scores (P=0.021). Among those with low bleeding risk, use of OAC increased significantly with increasing stroke risk. Among those with high bleeding risk, CHADS2 stroke risk had a smaller impact on use of OAC.Conclusions-In community-based outpatients with AF, use of OAC was high and driven by not only predominantly stroke but also bleeding risk. Stroke risk significantly affects OAC use among those with low bleeding risk, whereas those with high bleeding risk demonstrate consistently lower use of OAC regardless of stroke risk.
PMID: 23759473 [PubMed - as supplied by publisher]