Increased risk of acute MI on DOAC vs. VKA in real world AF patients
Risk of myocardial infarction in patients with atrial ﬁbrillation using vitamin K ant agonists, aspirin or direct acting oral anticoagulantsLiterature - Stolk LM, De Vries F, Ebbelaar C et al., - Br J Clin P harmacol 2017. DOI: 10.1111/bcp.13264
- The division of CHA2DS2-VASc score categories among the three treatment groups was balanced, with 25% having a low score (≤1), 25-30% having a high score (≥4) and the remainder having a medium score between 1 and 4. The distribution of antithrombotic use did not follow guidelines for stroke prevention in AF.
- The risk of AMI was increased when comparing current use of DOACs with current use of VKA (adj HR: 2.11, 95%CI: 1.08-4.12).
- A similarly increased risk was seen when comparing current use of aspirin with VKA (adjHR: 1.91, 95%CI: 1.45-2.51).
- When stratifying by gender, among aspirin users, men showed a 1.60 times increased risk of AMI (95%CI: 1.10-2.33) and women a 2.33-fold higher risk (95%CI: 1.55-3.50).
- When stratifying current users by CHA2DS2-VASc score at index date, among those with a high score, aspirin users showed a higher risk than VKA users (adjHR: 2.21, 95%CI: 1.37-3.55), while among those with a medium score, as compared with VKA users, an increased risk was seen in current DOAC users (adj HR: 2.67, 95%CI: 1.11-6.40) and in aspirin users (adjHR: 1.82, 95%CI: 1.23-2.68).
This analysis shows that in real-world patients with AF who are currently treated with DOACs or aspirin, the risk of AMI was doubled as compared with current users of VKA. After stratifying for gender, a significantly increased risk was only seen for users of aspirin. When stratifying for stroke risk based on CHA2DS2-VASc score, the risk of AMI remained significantly increased in high and medium risk patients on DOAC and aspirin, as compared with current users of VKAs.