Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation: Temporal trends 2011-2015 in Denmark

Sci Rep. 2016 Aug 11;6:31477. doi: 10.1038/srep31477.

Abstract

Among atrial fibrillation (AF) patients, Danish nationwide registries (2011-2015) were used to examine temporal trends of initiation patterns of oral anticoagulation (OAC) treatment according to age. Overall, 43,299 AF patients initiating vitamin K antagonists (VKA) (42%), dabigatran (29%), rivaroxaban (13%), or apixaban (16%) were included with mean age (SD) 72.1 (11.3), 71.5 (11.0), 74.3 (11.1), and 75.3 (11.1) years, respectively. Patients aged ≥85 years comprised 15%. Trend tests showed increase in patients ≥85 years initiating OAC (p < 0.0001). VKA usage decreased from 92% to 24% (p < 0.0001). This decrease was independent of age. Dabigatran was the most common non-VKA OAC (NOAC) (40% users), but usage decreased from 2014 until study end (6%) (p < 0.0001). Apixaban was the most used OAC at study end (41%), in particular among those ≥85 years (44%). Compared with patients aged <65 years, the odds ratios associated with initiating VKA, dabigatran, rivaroxaban, or apixaban for patients aged ≥85 years were 0.81 (95% CI 0.75-0.86), 0.65 (95% CI 0.60-0.70), 1.52 (95% CI 1.38-1.67), and 2.09 (95% CI 1.89-2.30), respectively. In conclusion, substantial increase in NOAC usage has occurred. Increasing age was associated with upstart of rivaroxaban or apixaban with reference to age <65 within the specific agent.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antithrombins / administration & dosage*
  • Antithrombins / therapeutic use
  • Atrial Fibrillation / drug therapy*
  • Dabigatran / administration & dosage
  • Dabigatran / therapeutic use
  • Denmark
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Patterns, Physicians'
  • Pyrazoles / administration & dosage
  • Pyrazoles / therapeutic use
  • Pyridones / administration & dosage
  • Pyridones / therapeutic use
  • Registries
  • Rivaroxaban / administration & dosage
  • Rivaroxaban / therapeutic use

Substances

  • Antithrombins
  • Pyrazoles
  • Pyridones
  • apixaban
  • Rivaroxaban
  • Dabigatran