Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and Antipsychotics
Major bleeding risks associated with non-vitamin K oral anticoagulants (NOACs) used with and without concurrent antipsychotics in patients with non-valvular atrial fibrillation (AF) were assessed. A total of 98,863 patients with non-valvular AF receiving at least one NOAC prescription from Taiwan’s...
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.819878/full |
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| author | Chiung-Mei Chen Chiung-Mei Chen Kuo-Hsuan Chang Kuo-Hsuan Chang Chun-Li Wang Chun-Li Wang Hui-Tzu Tu Yu-Tung Huang Hsiu-Chuan Wu Hsiu-Chuan Wu Chien-Hung Chang Chien-Hung Chang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang |
| author_facet | Chiung-Mei Chen Chiung-Mei Chen Kuo-Hsuan Chang Kuo-Hsuan Chang Chun-Li Wang Chun-Li Wang Hui-Tzu Tu Yu-Tung Huang Hsiu-Chuan Wu Hsiu-Chuan Wu Chien-Hung Chang Chien-Hung Chang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang |
| author_sort | Chiung-Mei Chen |
| collection | DOAJ |
| description | Major bleeding risks associated with non-vitamin K oral anticoagulants (NOACs) used with and without concurrent antipsychotics in patients with non-valvular atrial fibrillation (AF) were assessed. A total of 98,863 patients with non-valvular AF receiving at least one NOAC prescription from Taiwan’s National Health Insurance database were enrolled. Major bleeding was defined as a primary diagnosis of intracranial or gastrointestinal hemorrhage or bleeding at other sites. The adjusted incidence rate difference (AIRD) per 1,000 person-years and adjusted rate ratio of major bleeding were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score. A total of 8,037 major bleeding events occurred during 705,521 person-quarters with NOAC prescriptions. Antipsychotics were used in 26.35% of NOAC-exposed patients. Compared to using NOAC alone, co-medication of either typical (AIRD: 79.18, 95% confidence interval [CI]: 70.63–87.72) or atypical (AIRD: 40.5, 95% CI: 33.64–47.35) antipsychotic with NOAC had a significant increase in the adjusted incidence rate per 1,000 person-years of major bleeding. The concomitant use of a NOAC with chlorpromazine (AIRD: 103.87, 95% CI: 51.22–156.52), haloperidol (AIRD: 149.52, 95% CI: 125.03–174.00), prochlorperazine (AIRD: 90.43, 95% CI: 78.55–102.32), quetiapine (AIRD: 44.6, 95% CI: 37.11–52.09), or risperidone (AIRD: 41.55, 95% CI: 22.86–60.24) (All p < 0.01) showed a higher adjusted incidence rate of major bleeding than using NOACs alone. The concomitant use of typical (chlorpromazine, haloperidol, or prochlorperazine) or atypical (quetiapine or risperidone) antipsychotic with NOACs was associated with a significantly increased risk of major bleeding. |
| first_indexed | 2024-04-13T09:43:33Z |
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| language | English |
| last_indexed | 2024-04-13T09:43:33Z |
| publishDate | 2022-04-01 |
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| spelling | doaj.art-3bc6b7c7096644f1a894113711a577c82022-12-22T02:51:50ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-04-011310.3389/fphar.2022.819878819878Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and AntipsychoticsChiung-Mei Chen0Chiung-Mei Chen1Kuo-Hsuan Chang2Kuo-Hsuan Chang3Chun-Li Wang4Chun-Li Wang5Hui-Tzu Tu6Yu-Tung Huang7Hsiu-Chuan Wu8Hsiu-Chuan Wu9Chien-Hung Chang10Chien-Hung Chang11Shang-Hung Chang12Shang-Hung Chang13Shang-Hung Chang14Shang-Hung Chang15Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanCollege of Medicine, Chang Gung University, Taoyuan City, TaiwanDepartment of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanCollege of Medicine, Chang Gung University, Taoyuan City, TaiwanCollege of Medicine, Chang Gung University, Taoyuan City, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanDepartment of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanCollege of Medicine, Chang Gung University, Taoyuan City, TaiwanDepartment of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanCollege of Medicine, Chang Gung University, Taoyuan City, TaiwanCollege of Medicine, Chang Gung University, Taoyuan City, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanCenter for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, TaiwanGraduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan City, TaiwanMajor bleeding risks associated with non-vitamin K oral anticoagulants (NOACs) used with and without concurrent antipsychotics in patients with non-valvular atrial fibrillation (AF) were assessed. A total of 98,863 patients with non-valvular AF receiving at least one NOAC prescription from Taiwan’s National Health Insurance database were enrolled. Major bleeding was defined as a primary diagnosis of intracranial or gastrointestinal hemorrhage or bleeding at other sites. The adjusted incidence rate difference (AIRD) per 1,000 person-years and adjusted rate ratio of major bleeding were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score. A total of 8,037 major bleeding events occurred during 705,521 person-quarters with NOAC prescriptions. Antipsychotics were used in 26.35% of NOAC-exposed patients. Compared to using NOAC alone, co-medication of either typical (AIRD: 79.18, 95% confidence interval [CI]: 70.63–87.72) or atypical (AIRD: 40.5, 95% CI: 33.64–47.35) antipsychotic with NOAC had a significant increase in the adjusted incidence rate per 1,000 person-years of major bleeding. The concomitant use of a NOAC with chlorpromazine (AIRD: 103.87, 95% CI: 51.22–156.52), haloperidol (AIRD: 149.52, 95% CI: 125.03–174.00), prochlorperazine (AIRD: 90.43, 95% CI: 78.55–102.32), quetiapine (AIRD: 44.6, 95% CI: 37.11–52.09), or risperidone (AIRD: 41.55, 95% CI: 22.86–60.24) (All p < 0.01) showed a higher adjusted incidence rate of major bleeding than using NOACs alone. The concomitant use of typical (chlorpromazine, haloperidol, or prochlorperazine) or atypical (quetiapine or risperidone) antipsychotic with NOACs was associated with a significantly increased risk of major bleeding.https://www.frontiersin.org/articles/10.3389/fphar.2022.819878/fullmajor bleeding risknon-vitamin K oral anticoagulantantipsychoticsnon-valvular atrial fibrillationcombined medication |
| spellingShingle | Chiung-Mei Chen Chiung-Mei Chen Kuo-Hsuan Chang Kuo-Hsuan Chang Chun-Li Wang Chun-Li Wang Hui-Tzu Tu Yu-Tung Huang Hsiu-Chuan Wu Hsiu-Chuan Wu Chien-Hung Chang Chien-Hung Chang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and Antipsychotics Frontiers in Pharmacology major bleeding risk non-vitamin K oral anticoagulant antipsychotics non-valvular atrial fibrillation combined medication |
| title | Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and Antipsychotics |
| title_full | Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and Antipsychotics |
| title_fullStr | Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and Antipsychotics |
| title_full_unstemmed | Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and Antipsychotics |
| title_short | Major Bleeding Risk in Atrial Fibrillation Patients Co-Medicated With Non-Vitamin K Oral Anticoagulants and Antipsychotics |
| title_sort | major bleeding risk in atrial fibrillation patients co medicated with non vitamin k oral anticoagulants and antipsychotics |
| topic | major bleeding risk non-vitamin K oral anticoagulant antipsychotics non-valvular atrial fibrillation combined medication |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.819878/full |
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