Concomitant Using Statin and Direct Oral Anticoagulant Did Not Increase Intracerebral Hemorrhage Risk in Patients with Atrial Fibrillation: A National-wide Cohort Study
Chang Ting-Yu, MD 1 ,
1 Stroke Section, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
Wu Hsin-Hsu , MD
Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
Patients with atrial fibrillation (Af) often have other vascular risk factors and new oral anticoagulants (NOAC) are commonly prescribed in this patient group. Statins are also important in secondary prevention for cardiovascular events. Previous studies showed statin might increase the risk of intracerebral hemorrhage (ICH) in patients with stroke history. It is still unclear whether the concomitant using statin and NOAC will increase the risk of ICH or other major bleedings in patients with Af.
MATERIAL and METHOD:
We studied patients who were diagnosed as Af and taking NOACs registered in Taiwan National Health Insurance Program from June 2012 to December 2017. Adult patients with valvular heart disease, previous ICH history, cerebral vascular anomalies, or end-stage renal disease were excluded. A total of 90,731 patients were included in this study. The adjusted relative risks (RR) between person-quarters with or without statin using were calculated.
Compare to person-quarters of no statin using, the RR of ICH was 0.76 (0.72-0.81, 95% CI) in all statin using person-quarters. In person-quarters of high-potency statin using, the RR of ICH was 0.67 (0.52-0.88, 95% CI). In person-quarters of mid- and low-potency statin using, the RR of ICH was 0.86 (0.72-1.03, 95% CI).
Either high-potency statin or mid-, low-potency statin using did not increase the risk of ICH in Af patients without previous ICH history or having cerebral vascular anomalies. Concurrent statin using in Af patients tended to lower the risk of ICH.