(Absence of) Association Between Non-Vitamin K Antagonist Oral Anticoagulant Therapy and Urinary Tract Infection in Patients with Atrial Fibrillation.

ABSTRACT The aim of the present study is to identify a potential association of urinary tract infections in a large population of patients receiving oral anticoagulation therapy treated in general practices in Germany. This study contains patients diagnosed with atrial fibrillation (AF) who received at least one prescription of either NOAC or VKA within January 2015 and December 2018. The incidence of urinary tract infections was examined cumulatively on basis of Kaplan-Meier methods and was complemented by incidence rates measured in cases per 1,000 patient years. Sex-stratified Cox regressions were conducted to examine possible associations in specific sex groups. The study comprised 26,934 patients receiving NOAC therapy and 8,121 patients treated with VKA agents. Within a period of 5 years, slightly more NOAC than VKA users were diagnosed with UTI (20.3% vs. 19.3%), while the incidence rate was slightly higher in patients receiving NOAC therapy than those under VKA treatment (50.8 cases vs. 50.5 cases in 1,000 patient years). There was no significant association between direct oral anticoagulants versus vitamin-k antagonists and infections of the urinary tract. Our study did not identify any significant association between therapy with direct oral anticoagulants versus vitamin-k anticoagulants and urinary tract infections in patients diagnosed with atrial fibrillation in general practices in Germany. Since current findings regarding the risk of UTI in patients receiving OAC therapy remain limited and contradictory, further investigations including a broad patient population are necessary to determine patients at risk for UTI and reconcile conflicting evidence.