The adoption of direct oral anticoagulants for stroke prevention in atrial fibrillation.
Intern Med J. 2016 Apr 4;
Authors: Baker D, Wilsmore B, Narasimhan S
INTRODUCTION: The direct oral anticoagulants (DOACs) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter (AFL). The adoption and application of these drugs was analysed in a regional hospital inpatient cohort and compared to national prescribing data.
METHOD: Digital medical records identified prescribed anticoagulants for patients admitted with AF and AFL during 2013-14. Analysis of patient demographics and stroke risk identified trends in prescribing DOACs vs warfarin. For broader comparison, data from the Pharmaceuticals Benefits Scheme (PBS) was sourced to determine nation-wide adoption of DOACs.
RESULT: 615 patients were identified, of which 505 (255 in 2013, 250 in 2014) had sufficient records to include in the study. From 2013 to 2014, DOAC prescriptions increased from 9 to 28% (p < 0.001), warfarin and aspirin remained comparatively stable (38 to 34%, 22 to 20%), and those prescribed no medication declined (17 to 8%, p < 0.001). DOACs were prescribed to patients with lower CHA2 DS2 VASc scores than warfarin (3.6 vs 4.4; P = 0.005), lower HASBLED scores (1.7 vs 2.3; P < 0.01), higher glomerular filtration rates (GFR; 70 vs 63 ml/min; P = 0.002), and younger age (74 vs 77 years; P = 0.006). Nationally, warfarin prescriptions are higher in total numbers but increasing at a slower rate than DOACs, which increased ten-fold (101158 in 2013, 1095985 in 2014).
CONCLUSION: DOACs prescribing grew rapidly from 2013 to 2014, regionally and nationally. Warfarin prescriptions have remained stable, indicating that more patients are being appropriately anticoagulated for atrial fibrillation that previously were not. DOACs were found to be prescribed to patients with lower CHA2 DS2 VASc and HASBLED scores, younger age, and higher GFR. Aspirin therapy remains over utilised in AF.
PMID: 27040617 [PubMed - as supplied by publisher]