An increase in the number of people with atrial fibrillation taking anticoagulant drugs helped to prevent 4,000 strokes in England between 2015 and 2016, according to research published today.
Researchers at the University of Leeds, England, used national data and insight provided from Imperial College Health Partners (ICHP) to analyse the known patients with AF, episodes of stroke, new AF diagnoses and the use of anticoagulants amongst high risk patients between 2006 and 2016.
They found that, since 2009, the number of people with AF who are being treated with anticoagulants has more than doubled, estimating that, had the uptake of anticoagulants stayed at 2009 levels, there would have been about 4,000 more strokes in patients with AF in England in the 2015/16 financial year.
The research is published in the latest edition of the European Heart Journal.
It is believed that in the UK alone there are 500,000 people who have undiagnosed AF, a condition that increases the risk of a stroke five-fold.
The British Heart Foundation, which part-funded the study, says the findings highlight the urgent need for better screening and diagnosis of AF to ensure patients receive the clot-busting treatment to help prevent a stroke.
Study co-author Chris Gale, professor of cardiovascular medicine and honorary consultant cardiologist at the University of Leeds, said: “Sudden strokes in people who have AF are unnecessarily common. Treatments which prevent AF-related strokes are saving lives, but there are still many thousands of people in the UK living with undiagnosed AF who are missing out.
"The risk of AF rises dramatically with age. Our ageing population makes it clear that without intervention, cases of AF and associated strokes are only going to increase. It’s a truly preventable public health crisis.”
Professor Sir Nilesh Samani, BHF medical director, added: “This study demonstrates the real benefits to patients when research evidence is put into practice.
“The increased use of anticoagulants in patients with AF and the fall in the expected number of strokes is a major success story – but much more needs to be done. There are still half a million people in the UK with ‘silent’ AF, who have no idea they’re at risk of having a stroke.”
* New anti-clotting drugs seem to be a safe alternative to warfarin, an observational study has concluded.
Direct oral anticoagulants (DOACs), which are prescribed to treat serious blood clots, are associated with reduced risks of major bleeding compared with warfarin, according to researchers at the University of Nottingham, which investigated the risks and benefits of dabigatran, rivaroxaban, and apixaban – the three most commonly used DOACs – compared with warfarin in patients with and without atrial fibrillation.
They used data from two large UK primary care databases, identifying 196,061 patients who started or restarted anticoagulants, after more than a 12-month gap, between 2011 and 2016.
Of these, 132,231 patients were taking warfarin, 7,744 dabigatran, 37,863 rivaroxaban, and 18,223 apixaban. A total of 53% (103,270) were diagnosed with AF, while the remaining 47% (92,791) were prescribed anticoagulants for other conditions.
Patients were monitored for major bleeds leading to hospital admission or death, ischaemic stroke, VTE, and all-cause mortality.
Writing in The BMJ, the research team says it found apixaban was associated with a lower risk of major bleeding, particularly brain and gastric bleeds, in all patients, than the risk from warfarin.
They also found a lower risk of brain bleeds associated with use of dabigatran in patients with AF – and with use of rivaroxaban in patients without AF – than from warfarin.
However, rivaroxaban and low dose apixaban were associated with increased risks of deaths from any cause in all patients when compared with warfarin. The researchers say this may reflect closer monitoring of patients taking warfarin or may be related to other underlying conditions.
Although it is an observational study, the research team says its research shows that “the risk of major bleeding is lower in apixaban users regardless of the reason for prescribing, appearing to show apixaban to be the safest drug”.
They add: “Our results give an initial, reassuring, indication of the risk patterns for all patients taking anticoagulants, in particular with respect to those prescribed apixaban.”
European Heart Journal 6 July 2018
Vinogradova Y, Coupland C, Hill T et al. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ 4 July 2018. doi:10.1136/bmj.k2505
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