@article{01H46005NZ01ADG706MVYCWBMR,
  abstract     = {{Background: Polypharmacy may affect outcomes in patients with atrial fibrillation (AF) using non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) due to interactions or reduced adherence, but comparative data are lacking. Therefore, the impact of polypharmacy on AF-related outcomes and benefit-risk profiles of NOACs in patients with polypharmacy were investigated.
Methods: AF patients initiating anticoagulation between 2013-2019 were included using Belgian nationwide data. Inverse probability of treatment weighted Cox regression was used to investigate outcomes.
Results: Among 254,478 AF patients, 167,847 (66.0%) used ≥5 drugs. Polypharmacy was associated with higher stroke or systemic embolism (stroke/SE) (adjusted hazard ratio (aHR) 1.08, 95% confidence interval (CI) (1.02-1.15)), all-cause mortality (aHR 1.45, 95%CI (1.40-1.50)) and major bleeding risks (aHR 1.29, 95%CI (1.23-1.35)). Among patients with polypharmacy, NOACs were associated with lower stroke/SE (aHR 0.68, 95%CI (0.63-0.73)), all-cause mortality (aHR 0.80, 95%CI (0.77-0.84)), major bleeding (aHR 0.92, 95%CI (0.87-0.97)) and intracranial bleeding risks (aHR 0.77, 95%CI (0.69-0.85)), but higher gastrointestinal bleeding risks (aHR 1.10, 95%CI (1.01-1.19)) compared to VKAs. Major bleeding risks were lower with apixaban (aHR 0.79, 95%CI (0.74-0.85)), but non-significantly different with other NOACs compared to VKAs. Lower major bleedings risks were observed with dabigatran (aHR 0.91, 95%CI (0.85-0.97)) and apixaban (aHR 0.77, 95%CI (0.73-0.81)) compared to rivaroxaban, and with apixaban compared to dabigatran (HR 0.83, 95%CI (0.77-0.90)) and edoxaban (HR 0.77, 95%CI (0.70-0.85)).
Conclusion: Polypharmacy was associated with increased thromboembolic, bleeding and mortality risks in AF patients. NOACs had better benefit-risk profiles than VKAs in patients with polypharmacy.}},
  author       = {{Grymonprez, Maxim and Petrovic, Mirko and De Backer, Tine and Steurbaut, Stephane and Lahousse, Lies}},
  issn         = {{0340-6245}},
  journal      = {{THROMBOSIS AND HAEMOSTASIS}},
  keywords     = {{atrial fibrillation,polyphramacy,NOAC,thromboembolism,haemorrhage}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{135--148}},
  publisher    = {{Georg Thieme Verlag KG}},
  title        = {{The impact of polypharmacy on the effectiveness and safety of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation}},
  url          = {{http://doi.org/10.1055/s-0043-1769735}},
  volume       = {{124}},
  year         = {{2024}},
}

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