Association between first anticoagulant prescription and embolic and hemorrhagic events among older adults with atrial fibrillation
Rattachement africain : us, de. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: The impact of first prescription of oral anticoagulation on ischemic stroke and major bleeding events among Medicare beneficiaries with atrial fibrillation (AF) is not known. METHODS: A retrospective, observational, cohort study was performed based on a 5% sample of United States fee-for-service Medicare beneficiaries aged ≥66 years who developed AF from 2007 to 2020. The principal exposure was first prescription of an oral anticoagulant. The primary effectiveness end point was ischemic stroke (including cerebral or retinal ischemic stroke [central retinal artery occlusion]). The primary safety end point was major bleeding. To reduce the impact of selection bias and immortal time bias, unadjusted and adjusted hazard ratios (HRs) and rate differences were computed in a dataset comprised of pooled, sequential clinical trial replicates starting 1 month apart. RESULTS: In total, 144,969 patients (60.8% female; mean age 77.7 years [standard deviation (SD) 7.1]) were included in the study. First prescription of oral anticoagulation was not associated with a reduced hazard of ischemic stroke (adjusted HR [aHR] 1.01 [95% confidence interval (CI): 0.97-1.05]). However, first prescription of oral anticoagulation was associated with an increased hazard of a major bleeding event (aHR 1.38 [95% CI: 1.36-1.40]) and increased hazards of intracerebral hemorrhage (ICH) and major gastrointestinal hemorrhage. CONCLUSIONS: In this cohort study of Medicare beneficiaries aged 66 years and older with incident AF, the first anticoagulant prescription was not associated with a reduced hazard of ischemic stroke. Furthermore, unadjusted models suggested that clinicians are likely appropriately selecting patients for anticoagulation in routine clinical practice.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Association between first anticoagulant prescription and embolic and hemorrhagic events among older adults with atrial fibrillation
- Date Crossref
- 10/11/2025
- Éditeur
- Wiley
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
-
University of North Carolina at Chapel Hill Department of Family Medicine pays non établi dans la noticeUniversité ou école supérieure
-
Duke University Department of Neurology pays non établi dans la noticeUniversité ou école supérieure
-
Clinical Research Institute pays non établi dans la noticeStructure de recherche
-
Yale University Department of Psychiatry pays non établi dans la noticeUniversité ou école supérieure
-
Vanderbilt University Department of Neurology pays non établi dans la noticeUniversité ou école supérieure
-
Hertie Institute for Clinical Brain Research pays non établi dans la noticeInstitution
-
University of Tübingen Department of Neurology & pays non établi dans la noticeUniversité ou école supérieure
-
Department of Family Medicine University of North Carolina Chapel Hill North Carolina USA pays non établi dans la noticeUniversité ou école supérieure
Department of Family Medicine — University of North Carolina at Chapel Hill, Department of Neurology — Duke University et Clinical Research Institute, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.