P3621Incidence of ischemic stroke in a pacemaker population Article Swipe

Background/Introduction: The pattern of use of non-vitamin K antagonist oral anticoagulants (NOAC) in the management of non-valvular atrial fibrillation (NVAF) and the rates of haemorrhage associated with their use under real-life conditions are still broadly unknown in France.Purpose: To describe patterns of use for dabigatran, rivaroxaban, apixaban, and VKA as well as to assess the rates of haemorrhage according to OAC therapy.Methods: Data from patients participating in the PGRx-Atrial fibrillation systematic registry assembled by 118 cardiologists and 32 general practitioners from December 2013 to October 2016 were analysed.A total of 3693 patients with NVAF, who underwent also an interview, were retained for the treatment patterns analysis, of whom 2850 patients treated with anticoagulants over the 12 months prior to recruitment were considered for the study of haemorrhage.Recruiting physicians collected data on diagnosis and comorbidities for enrolled patients.Patients' interviews detailed retrospectively the one-year history of OAC treatment and haemorrhage ahead of study onset.Results: VKA users were 76.4 [8.7] y.o. on average vs. 73.5 [9.4], 72.1 [9.8] and 73.4 [9.5] y.o. for dabigatran, rivaroxaban and apixaban users, respectively.There were 66.3%, 65.0%, 63.6%, and 61.1% males amongst VKA, dabigatran, rivaroxaban and apixaban users, respectively.NOAC users had permanent NVAF less often than VKA users (41.9%, 30.9%, and 20.5%.respectively, vs. 53.7%).Switching -from and to any OAC drug -rate was low and around 6.9% overall.Incident users were switched to any OAC treatment in 8.3%, 5.5%, 5.8%, and 2.8% of patients respectively for dabigatran, VKA, rivaroxaban, and apixaban.Proportions of switchers across the prevalent OAC Users' subpopulations were similar (7.8%, 8.6%, 5.8%, 4.5%, respectively).OAC were continued in 90% of patients, a percentage that remained unchanged regardless of the drug.Discontinuation at 12 months occurred in 2.9% of patients on average, with no difference across OAC.The incidence rate per 100 patient/year of experiencing a major haemorrhage episode was 2.57 [1.99 -3.15] overall, with 1.22 [0.00 -2.45], 1.83 [0.82 -2.83], 1.32 [0.01 -2.62], 6.73 [2.59 -10.87], 2.88 [2.01 -3.74] respectively in users of dabigatran, rivaroxaban, and apixaban, in switchers, and in VKA users.The HAS-BLED score and any interruption were statistically significant when associated with risk of major haemorrhage, with OAC interruption showing a high OR of 4. 47 [2.61 -7.66].Conclusion: NOAC were used in younger patients, with a more recent diagnosis of AF and less likely permanent AF than VKA users.On average, switching and discontinuation rates were low.NOAC exhibited lower rates of major bleeding, which may be a reflection of both their mechanism of action and differences in the populations treated.Acknowledgement/Funding: Study conception and data analyses were conducted independently of Boehringer Ingelheim that subscribed data from PGRx data registry for the SPAstudy