Risk of suicide in patients with atrial fibrillation receiving different oral anticoagulants: a nationwide analysis using target trial emulation framework.

IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL BMC Medicine Pub Date : 2024-10-11 DOI:10.1186/s12916-024-03645-z
Brian Meng-Hsun Li, Avery Shuei-He Yang, Michael Chun-Yuan Cheng, Huei-Kai Huang, Edward Chia-Cheng Lai
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Abstract

Background: The suicide risk in patients with atrial fibrillation receiving novel oral anticoagulants or warfarin has not been evaluated in real-world practice. Moreover, reducing vitamin K levels may increase the suicide risk, underscoring the importance of selecting appropriate oral anticoagulants to prevent unintended outcomes. Therefore, we aimed to evaluate the association between different types of oral anticoagulants and the risk of attempted and completed suicide among patients with atrial fibrillation.

Methods: This nationwide study retrieved data from Taiwan's National Health Insurance Research Database from 2012 to 2020. This study included patients with atrial fibrillation aged 20 years and older who newly received oral anticoagulant treatment, and who had no contraindications for NOACs and no history of suicide-related events. The main outcomes were suicide-related outcomes, including attempted suicide and completed suicide. This study employed the target trial emulation framework to improve the causal inference for the observed association.  RESULTS: A total of 103,768 (71.74%) patients taking NOACs and 40,877 (28.26%) patients taking warfarin were included in this study. Compared to those receiving warfarin, patients receiving NOACs were associated with a lower risk of suicide-related outcomes (HR, 0.82; 95% CIs, 0.69-0.96).

Conclusions: The findings of this cohort study suggested that patients receiving NOACs were associated with a lower risk of suicidal attempts but similar risk of complete suicide, compared to those receiving warfarin. Considering the risk of suicide, NOACs could be the preferred anticoagulants for patients with atrial fibrillation.

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接受不同口服抗凝药物治疗的心房颤动患者的自杀风险:利用目标试验仿真框架进行的全国性分析。
背景:接受新型口服抗凝药或华法林治疗的心房颤动患者的自杀风险尚未在实际应用中进行评估。此外,降低维生素 K 水平可能会增加自杀风险,这就强调了选择适当口服抗凝药以防止意外结果发生的重要性。因此,我们旨在评估不同类型的口服抗凝药与心房颤动患者企图自杀和自杀未遂风险之间的关联:这项全国性研究从台湾国民健康保险研究数据库中检索了 2012 年至 2020 年的数据。研究对象包括年龄在20岁及以上、新近接受口服抗凝剂治疗的心房颤动患者,这些患者没有NOACs禁忌症,也没有自杀相关病史。主要结果为自杀相关结果,包括自杀未遂和自杀完成。本研究采用了目标试验仿真框架,以改进观察到的关联的因果推断。 结果:本研究共纳入了 103,768 例(71.74%)服用 NOACs 的患者和 40,877 例(28.26%)服用华法林的患者。与服用华法林的患者相比,服用 NOACs 的患者发生自杀相关结果的风险较低(HR,0.82;95% CIs,0.69-0.96):这项队列研究的结果表明,与接受华法林治疗的患者相比,接受 NOACs 治疗的患者自杀未遂的风险较低,但完全自杀的风险相似。考虑到自杀风险,NOACs 可作为心房颤动患者的首选抗凝药物。
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来源期刊
BMC Medicine
BMC Medicine 医学-医学:内科
CiteScore
13.10
自引率
1.10%
发文量
435
审稿时长
4-8 weeks
期刊介绍: BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.
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