Version FINAL Rev 140813

Version FINAL rev 140813

Electronic Supplementary Material

All Warfarin Aspirin treatment*

n 41810 15680 14236 9959

Clopidogrel 2,0% 0,3% 2,5% 0,0%

Low molecular weight heparin 3,3% 4,1% 2,1% 3,1%

Antihypertensive or antianginal drugs 85,9% 94,7% 92,2% 60,8%

Lipid-lowering drugs 31,7% 40,3% 31,8% 14,1%

Insulin 5,9% 6,2% 6,7% 3,9%

Oral antidiabetic drugs 8,3% 10,6% 8,1% 4,1%

*clopidogrel excluded

Supplementary Table 1 – Other drug treatment among 41 810 atrial fibrillation patients in the Stockholm County Council.

1 Version FINAL rev 140813

Supplementary Figure 1 – Factors contributing to CHA2DS2VASc scores 1 and 2 in 9 032 AF patients with warfarin, aspirin or no treatment*.

*clopidogrel excluded

Supplementary Figure 2 –Risks of suffering ischemic (IS) and hemorrhagic stroke (HS) during 2010 in 41810 AF patients, warfarin vs. no warfarin (i.e. aspirin or no treatment according to [3]).

Patients who had claimed prescriptions of both warfarin and aspirin are included in the warfarin group.

The patients having claimed both warfarin and aspirin between between July 1st 2009 and Dec 31st

2009 (n=1574) represented 3.8% of the total atrial fibrillation cohort. They were younger than the patients in the warfarin and aspirin groups: their mean age was 72.3 years and 71.1 % were under

the age of 80. The majority were men (63.0%). The mean CHA2DS2VASc score was 4.0 and 47.9% had vascular disease, which was more common than in the other treatment groups. Also, diabetes

(24.5%) and hypertension (72.2%) were slightly more common. Other co-morbidity was similar to the warfarin treated patients, while clopidogrel (5.8%) and lipid lowering treatment (53.2%) were more common.

Their risk of suffering ischemic stroke was 5.2%, thromboembolism 7.2%, hemorrhagic stroke 0.8%, traumatic intracranial bleeding 0.3%, any severe bleed 3.4%, and death 9.0%

Supplementary Text – Characteristics and Outcomes of 1574 AF Patients Claiming both Warfarin and Aspirin

Diagnosis ICD-code beginning with

Alcohol abuse E244, F10, G312, G621, G721, I426, K292, K70,

K860, O354, P043, Q860, T51, Y90-91, Z502, Z714

Anemia D50-64

Any severe bleed I60-62, I690-I692,, S064-S066, I850, I983, K25-28

(subcodes 0-2 and 4-6 only), K625, K922, D629

Atrial fibrillation I48

Cancer entire C-series

Cardioversion Procedure codes DF026, DF027

COPD/Emphysema J43-44

Dementia F00-F03

Diabetes E10-E14

Frequent falls (more than one W00-19 registration)

Gastric duadenal bleeding K25-28 (subcodes 0-2 and 4-6 only)

Heart failure I50

Hypertension I10-I15

Ischemic stroke, arterial I63, I64, I679, I693, I694, I698, I67-, I69-, Z866, embolism, and stroke, Z867, G450, G451, G452, G453, G458, G45.9, unspecified G45-, I74

Intracranial bleeding I60-I62, I690-I692, S064-S066

Liver disease K70-77

Mechanical valve Procedure codes FCA60, FCA70, FDC10, FGE00,

FGE10, FGE20, FGE96, FJF00, FJF10, FJF12, FJF20,

FJF96, FKD00, FKD10, FKD20, FKD96, FMD00,

FMD10, FMD12, FMD13, FMD20, FMD30, FMD40,

Mitral stenosis I050, I052, I342

Obesity E65-66

Renal disease N17-19

Vascular disease I20-I25, I70, I739

Venous thromboembolism I26, I80-I82

Outcomes

(only inpatient care or specialist ambulatory care)

Any severe bleed I60-62, S064-S066, I850, I983, K25-28 (subcodes

0-2 and 4-6 only), K625, K922, D629

Intracranial bleeding I60-I62, S064-S066

Ischemic stroke I63

Hemorrhagic stroke I60-I62

Thromboembolism I63, I64, G450, G451, G452, G453, G458, G459,

Traumatic intracranial bleeding S064-S066

Supplementary Appendix A - Definitions of co-morbidities and outcomes by ICD-10, primary care codes and procedure codes.

Treatment ATC-code beginning with

Acetylsalicylic acid (aspirin) B01AC06

Antihypertensive drugs C03, C07, C08, C09

Clopidogrel B01AC04

Insulin A10A

Lipid-lowering treatment C10

Low molecular weight heparin B01AB04, B01AB05

Oral antidiabetic treatment A10B

Warfarin B01AA

Supplementary Appendix B – ATC-codes of concomitant treatments.