title: Long-term vitamin K antagonists treatment patterns of Non-Valvular Atrial Fibrillation (NVAF): a population-based cohort study.
abstract: BACKGROUND
  Recent trends in vitamin K antagonists (VKA) use in non-valvular atrial fibrillation (NVAF) are useful to evaluate the potential improvement in management of NVAF since the introduction of new oral anticoagulants. Our objective was therefore to describe the contemporary VKA treatment patterns following NVAF diagnosis.
  
  
  RESULTS
  We used the computerized databases of the Régie de l'assurance maladie du Québec (RAMQ), responsible for administering the universal health care services for all its residents, to identify a population-based cohort of 135,241 patients with an incident diagnosis of NVAF during 2000-2009 and RAMQ medication coverage. Following NVAF diagnosis, 47.1 % of the patients were prescribed VKA, 35.5 % received an antiplatelet only, and 17.4 % did not initiate antithrombotic therapy. The proportion of patients initiating VKA within 3 months of diagnosis increased from 33 % to 39 % over the 10-year study period, mainly driven by a higher proportion of treated patients aged 80 or more (from 29 % to 41 %). At the end of the study period, women were prescribed VKA as frequently as men, except in the subgroup of patients with a low risk of ischemic stroke. The median time from VKA initiation to the first discontinuation varied greatly according to the definition of discontinuation, ranging from 11 months to 5.7 years.
  
  
  CONCLUSIONS
  Although VKA remain underused after NVAF diagnosis, there has been an increase in VKA treatment over the last decade, particularly among older patients. Also the gap in treatment between men and women has been closing within the last decade. Once initiated, most VKA interruptions were temporary rather than definitive.
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine, H-461, Montréal, Québec, H3T 1E2, Canada.|Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada.|Department of Epidemiology and Biostatistics, McGill University, Montréal, Québec, Canada.
authors.forename: Christel
authors.initials: C
authors.lastname: Renoux
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine, H-461, Montréal, Québec, H3T 1E2, Canada.
authors.forename: Janie
authors.initials: J
authors.lastname: Coulombe
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine, H-461, Montréal, Québec, H3T 1E2, Canada. samy.suissa@mcgill.ca.|Department of Epidemiology and Biostatistics, McGill University, Montréal, Québec, Canada. samy.suissa@mcgill.ca.
authors.forename: Samy
authors.initials: S
authors.lastname: Suissa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K
keywords: Anticoagulants; Atrial fibrillation; Cohort studies; Epidemiology; Sex