title: Nine-Year Trend of Anticoagulation Use, Thromboembolic Events, and Major Bleeding in Patients With Non-Valvular Atrial Fibrillation　- Shinken Database Analysis.
abstract: BACKGROUND
  Trends of oral anticoagulant (OAC) prescription and incidence of thromboembolism (TE) and/or major bleeding (MB) in patients with non-valvular atrial fibrillation (NVAF) in Japan are still unclear.
  
  
  RESULTS
  We used data from Shinken Database 2004-2012, which included all new patients attending the Cardiovascular Institute between June 2004 and March 2013. Of them, 2,434 patients were diagnosed with NVAF. Patients were divided into 3 time periods according to the year of initial visit: 2004-2006 (n=681), 2007-2009 (n=833), and 2010-2012 (n=920). OAC prescription rate steadily increased from 2004-2006 to 2010-2012. Between 2004-2006 and 2007-2009, irrespective of increased warfarin usage, MB tended to decrease, presumably due to low-intensity therapy and avoidance of concomitant use of dual antiplatelets, but TE did not improve. In 2010-2012, direct OACs (DOAC), preferred in low-risk patients, may have contributed to not only decrease TE, but also increase MB, especially extracranial bleeds. In high-risk patients in that time period, mostly treated with warfarin, incidence of TE and MB did not improve.
  
  
  CONCLUSIONS
  The 9-year trend of stroke prevention indicated a steady increase of OAC prescription and a partial improvement of TE and MB. Even in the era of DOAC, TE prevention was insufficient in high-risk patients, and DOAC were associated with increased extracranial bleeding. (Circ J 2016; 80: 639-649).
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute.
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Semba
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kano
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kato
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013923:Thromboembolism / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D000925:Anticoagulants