{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:41:25Z","timestamp":1790077285057,"version":"4.0.1"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Direct oral anticoagulants (\n              <jats:styled-content style=\"fixed-case\">DOAC<\/jats:styled-content>\n              s) are noninferior to warfarin for stroke prevention in atrial fibrillation (\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              ). We aimed to determine the population risk of stroke and death in incident\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              , stratified by anticoagulation status and type, and the temporal trends of oral anticoagulation practice in the post\u2010\n              <jats:styled-content style=\"fixed-case\">DOAC<\/jats:styled-content>\n              approval period.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We conducted a population\u2010based cohort study of incident nonvalvular\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              cases using administrative health data in Alberta, Canada. We used Cox proportional hazards modeling with anticoagulation status as a time\u2010varying exposure and adjusted for age (continuous), sex, congestive heart failure, hypertension, diabetes mellitus, prior transient ischemic attack or ischemic stroke, myocardial infarction, peripheral artery disease, and chronic kidney disease. Primary outcome was the composite of stroke and death. Among 34\u00a0965 patients with incident\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              (56.0% male, median age 73\u00a0years), relative to warfarin,\n              <jats:styled-content style=\"fixed-case\">DOAC<\/jats:styled-content>\n              use was associated with decreased risk of all stroke and death (hazard ratio: 0.90; 95% confidence interval, 0.83\u20130.97) and decreased hemorrhagic stroke (hazard ratio: 0.60; 95% confidence interval, 0.40\u20130.91]) but a similar risk of ischemic stroke (hazard ratio: 1.12; 95% confidence interval, 0.94\u20131.34]). During this time period,\n              <jats:styled-content style=\"fixed-case\">DOAC<\/jats:styled-content>\n              use increased rapidly, surpassing warfarin, but the total oral anticoagulation use in the population remained stable, even in the subgroup with the highest thromboembolic risk.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In a real\u2010world population\u2010based study of patients with incident\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              , anticoagulation with\n              <jats:styled-content style=\"fixed-case\">DOAC<\/jats:styled-content>\n              s was associated with decreased risk of stroke and death compared with warfarin. Despite a rapid uptake of\n              <jats:styled-content style=\"fixed-case\">DOAC<\/jats:styled-content>\n              s in clinical practice, the total proportion of\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              patients on anticoagulation has remained stable, even in high\u2010risk patients.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.007129","type":"journal-article","created":{"date-parts":[[2017,10,29]],"date-time":"2017-10-29T00:10:13Z","timestamp":1509235813000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":53,"title":["Temporal Trends in the Use and Comparative Effectiveness of Direct Oral Anticoagulant Agents Versus Warfarin for Nonvalvular Atrial Fibrillation: A Canadian Population\u2010Based Study"],"prefix":"10.1161","volume":"6","author":[{"given":"Amy Y. 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