Risk of Thromboembolic Events in Patients with Non-Valvular Atrial Fibrillation After Dabigatran or Rivaroxaban Discontinuation - Data from the Ljubljana Registry.
OBJECTIVE
Interruption of anticoagulant treatment with warfarin or non-vitamin K antagonist oral anticoagulants (NOAC) represents a vulnerable period with an increased risk of thromboembolic events. What is the incidence of thromboembolic events in real-life patients with non-valvular atrial fibrillation treated with NOAC who had a discontinuation or cessation of treatment in comparison to patients on continuous treatment?


METHODS
Registry data from 866 patients with non-valvular atrial fibrillation, aged 74.3 (SD 9.8) years, with an average CHADS2 score of 2.1 (SD 1.2), who were started on dabigatran or rivaroxaban, were analysed for thromboembolic events and survival. Patients who had temporary or permanent discontinuation of NOAC were compared to patients on continuous NOAC treatment.


RESULTS
Among 866 patients started on NOAC, 705 were treated without interruption, 84 patients had temporary interruption (69 because of planned invasive procedures, 10 due to bleeding, 5 for other causes) and 77 had permanent cessation of NOAC treatment. In patients without interruptions, the incidence of thromboembolic events was 1.0 (95% CI 0.4-2.1) per 100 patient-years, while in patients with interruption/cessation the rate of thromboembolic events was 21.6 (95% CI 10.3-45.2) per 100 patient-years, p < 0.001. There was a distinct clustering of thromboembolic events in the first weeks of NOAC discontinuation with the median occurring on day 14 (range 1-37 days) after discontinuation.


CONCLUSIONS
Dabigatran and rivaroxaban offered good protection against thromboembolic events during treatment, but interruption of NOAC treatment increased the short-term thromboembolic risk more than 20-fold.
Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Nina
N
Vene
Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Division of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Alenka
A
Mavri
Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Mirjam
M
Gubenšek
Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Division of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Gregor
G
Tratar
Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Division of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Tjaša
T
Vižintin Cuderman
Institute of Biomedical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Maja
M
Pohar Perme
Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Division of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Aleš
http://orcid.org/0000-0002-7538-1595
A
Blinc
D000368:Aged; D000991:Antithrombins / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D000069604:Dabigatran / Q000009:adverse effects*; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012042:Registries; D012307:Risk Factors; D000069552:Rivaroxaban / Q000009:adverse effects*; D017524:Slovenia / Q000453:epidemiology; D013923:Thromboembolism / Q000139:chemically induced* / Q000453:epidemiology*
D000991:Antithrombins; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban; D000069604:Dabigatran