Risk of myocardial infarction in patients with atrial fibrillation using vitamin K antagonists, aspirin or direct acting oral anticoagulants

Leo M. Stolk*, Frank de Vries, Chiel Ebbelaar, Anthonius de Boer, Tom Schalekamp, Patrick Souverein, Arina ten Cate-Hoek, Andrea M. Burden

*Corresponding author for this work

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Abstract

AimDirect-acting oral anticoagulants (DOACs) have become available for the prevention of stroke in patients with atrial fibrillation (AF). Conflicting results have been published on the risk of acute myocardial infarction (AMI) with the use of DOACs in comparison with vitamin K antagonists (VKAs). The objective of the present study was to evaluate the risk of AMI in patients with AF who are exposed to either VKAs, DOACs or low-dose (<325mg) aspirin.

MethodsWe conducted a population-based cohort study using data from the Clinical Practice Research Datalink (2008-2014). The study population (n=30146) consisted of all patients 18years with a diagnosis of AF who were new users of VKAs, DOACs (rivaroxaban and dabigatran) or aspirin. Cox proportional hazards models were used to estimate the hazard ratio (HR) of AMI for users of DOACs or aspirin vs. VKA. Adjustments were made for age, gender, lifestyle, risk factors, comorbidity and other drugs.

ResultsThe risk of AMI was doubled when we compared current use of DOACs with current use of VKAs [adjusted HR 2.11; 95% confidence interval (CI) 1.08, 4.12] and for current users of aspirin vs. current VKA users (adjusted HR 1.91; 95% CI 1.45, 2.51).

ConclusionsThere is a twofold increase in the risk of AMI for users of DOACs, in comparison with VKAs, in AF therapy. In addition, the results suggested that in patients with AF, the incidence of AMI is higher during aspirin monotherapy than during the use of VKAs.

Original languageEnglish
Pages (from-to)1835-1843
Number of pages9
JournalBritish Journal of Clinical Pharmacology
Volume83
Issue number8
DOIs
Publication statusPublished - Aug 2017

Keywords

  • anticoagulants
  • cardiovascular pharmacology
  • pharmacoepidemiology
  • RANDOMIZED-CONTROLLED-TRIALS
  • INTERVENTIONAL TRIALS
  • NATIONWIDE COHORT
  • WARFARIN
  • DABIGATRAN
  • METAANALYSIS
  • SAFETY
  • EFFICACY
  • STROKE
  • ASSOCIATION

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