Mar 1, 2015

Factors driving anticoagulant selection in patients with atrial fibrillation in the United States

The American Journal of Cardiology
Julie C LauffenburgerGang Fang

Abstract

With the introduction of novel oral anticoagulants (NOACs), the factors driving anticoagulant selection in atrial fibrillation (AF) in real-world practice are unclear. The goal was to examine whether and to what extent utilization has been driven by predictions of stroke risk (treatment benefit), bleeding risk (treatment harm), or prescription benefits' coverage. We extracted a cohort of patients with nonvalvular AF initiating anticoagulation from October 2010 to December 2012 from a large US database of commercial and Medicare supplement claims. Multivariable regression examined associations between ischemic stroke (CHA2DS2-VASc) and bleeding (Anticoagulation and Risk Factors in Atrial Fibrillation [ATRIA]) risk scores and benefits' generosity (proportion of costs covered by patients relative to total) with warfarin and novel oral anticoagulant (NOAC) selection and also between dabigatran and rivaroxaban. C-statistics and partial chi-square statistics were used to assess the variation explained. Of 70,498 patients initiating anticoagulation, 29.9% and 7.9% used dabigatran and rivaroxaban, respectively. Compared with warfarin, patients were less likely to receive an NOAC with high ischemic stroke risk (CHA2DS2-VASc ≥2; adjusted...Continue Reading

Mentioned in this Paper

Ischemic Cerebrovascular Accident
Prescription Procedure
Peptic Ulcer
Coronary Artery Disease
Anticoagulants, Oral
Venous Thromboembolism
Digoxin
Negative Regulation of Coagulation
Warfarin
Decreased Coagulation Activity [PE]

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