title: Major Bleeding Complications and Persistence With Oral Anticoagulation in Non-Valvular Atrial Fibrillation: Contemporary Findings in Real-Life Danish Patients.
abstract: The nonvitamin K antagonist oral anticoagulants have recently become available as an alternative to warfarin as stroke prophylaxis in atrial fibrillation, but data on real-life patient experience, including bleeding risk, are lacking. Our objective was to compare major bleeding events and nonpersistence between the nonvitamin K antagonist oral anticoagulant apixaban and other nonvitamin K antagonist oral anticoagulants (dabigatran and rivaroxaban) and warfarin in a contemporary, nation-wide cohort of patients with nonvalvular atrial fibrillation.
  
  
  
  Of 54 321 patients (median age, 73 years; 56% male; mean CHA2DS2-VASc score, 2.9), 7963, 6715, 15 413, and 24 230 patients initiated apixaban, rivaroxaban, dabigatran, and warfarin, respectively. Apixaban and rivaroxaban initiators were older, less often male, with higher HAS-BLED and CHA2DS2-VASc scores compared with dabigatran and warfarin initiators. A total of 2418 patients (4.5%) experienced a major bleeding event over all available follow-up. In this period, rivaroxaban (hazard ratio [HR] [95% CI], 1.49 [1.27-1.77]), dabigatran (HR, 1.17 [1.00-1.38]), and warfarin (HR, 1.23 [1.05-1.43]) users were significantly more likely to bleed than apixaban users. Findings were similar when restricted to the first 30 days after OAC initiation. Risk of nonpersistence was higher for dabigatran (HR, 1.45 [1.33-1.59]) and warfarin initiators (HR, 1.22 [1.12-1.33]), but not for rivaroxaban initiators (HR, 1.07 [0.96-1.20]) compared with apixaban initiators.
  
  
  
  In a real-world cohort of nonvalvular atrial fibrillation patients, apixaban had a lower adjusted major bleeding risk compared with rivaroxaban, dabigatran, and warfarin. Apixaban had a lower risk of nonpersistence compared with dabigatran and warfarin and similar risk compared with rivaroxaban.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark mortenlamberts@gmail.com.|Department of Cardiology, Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Lamberts
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
authors.forename: Laila
authors.initials: L
authors.lastname: Staerk
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
authors.forename: Jonas Bjerring
authors.initials: JB
authors.lastname: Olesen
authors.affiliation: Department of Cardiology, Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.|The Danish Heart Foundation, Copenhagen, Denmark.
authors.forename: Emil Loldrup
authors.initials: EL
authors.lastname: Fosbøl
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Morten Lock
authors.initials: ML
authors.lastname: Hansen
authors.affiliation: Bristol-Myers Squibb, Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Harboe
authors.affiliation: Bristol-Myers Squibb, Paris, France.
authors.forename: Cinira
authors.initials: C
authors.lastname: Lefevre
authors.affiliation: Bristol-Myers Squibb, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Evans
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.|The Danish Heart Foundation, Copenhagen, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.|The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Gunnar Hilmar
authors.initials: GH
authors.lastname: Gislason
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D001777:Blood Coagulation / Q000187:drug effects*; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003718:Denmark / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D015912:Thrombolytic Therapy / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants
keywords: anticoagulant; atrial fibrillation; bleeding