title: Thromboembolic events, bleeding, and drug discontinuation in patients with atrial fibrillation on anticoagulation: a prospective hospital-based registry.
abstract: The clinical practice of stroke prevention in atrial fibrillation (AF) with direct oral anticoagulants (DOACS) differs from anticoagulation in randomized trial patients. We investigated the risk of thromboembolism, bleeding, and drug discontinuation in a hospital-based real-world setting.
  
  
  
  All-comer patients with non-valvular AF were recruited into a registry at an academic tertiary care center. After informed consent, patients underwent a personal structured interview including medical history, past and current anticoagulation, and returned for follow-up after 6-12 months.
  
  
  
  The registry comprised 282 patients (42% women, median age 71 years) with a median CHA2DS2-Vasc-Score of 4 (25. to 75. percentile 2.5-5), who were prospectively followed 285 days in median. At inclusion, 118 patients took vitamin-K-antagonists, 33 dabigatran, 87 rivaroxaban, 30 apixaban, 5 low-molecular-weight heparin, and 9 were on no anticoagulant. Occurrence of stroke (rate 2.8/100 patient-years), was associated with prior stroke (hazard ratio [HR] 18.5, 95% confidence interval 2.16-159), increased HbA1c (HR per 1% increase 1.71, 1.20-2.45) and borderline significantly associated with vascular disease (HR 8.33, 0.97-71.3). Further we observed a high rate of major bleeding (2.8/100 patient-years), clinically relevant non-major bleeding (4.1/100 patient-years), and venous thromboembolism (2.8/100 patient-years). Anticoagulation was discontinued by 80 patients (36.9/100 patient-years), and diabetes (HR 2.31, 1.32-4.02), history of bleeding (HR 2.51, 1.44-4.37) and elevated leucocyte count (HR per 1G/l increase 1.02, 1.00-1.05) were associated with increased risk of discontinuation.
  
  
  
  In this hospital-based registry, patients with atrial fibrillation had an increased risk of thromboembolic events despite anticoagulation. The low drug persistence may be attributable to distinct comorbid conditions and bleeding complications.
authors.affiliation: Department of Medicine I, Clinical Division of Hematology & Hemostaseology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria. oliver.koenigsbruegge@meduniwien.ac.at.
authors.forename: Oliver
authors.identifier: 0000-0002-6183-3685
authors.initials: O
authors.lastname: Königsbrügge
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Simon
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Hans
authors.initials: H
authors.lastname: Domanovits
authors.affiliation: Department of Medicine I, Clinical Division of Hematology & Hemostaseology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Pabinger
authors.affiliation: Department of Medicine I, Clinical Division of Hematology & Hemostaseology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.|Department of Medicine, Thrombosis and Hemostasis Program, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Cihan
authors.initials: C
authors.lastname: Ay
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood / Q000628:therapy*; D001317:Austria / Q000453:epidemiology; D001777:Blood Coagulation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D062606:Tertiary Care Centers; D013923:Thromboembolism / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; Hemorrhage; Medication persistence; Stroke; Tertiary healthcare